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<^-Hrf-*C— i^' 


/■' 


THE 


CANADIAN 


Journal  of  Medical  SGlence; 


A    MONTHLY    JOURNAL 


or 


BRITISH  AND  FOREIGN  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


U.  OGDEN,  M.D.,  } 

R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond.,       S 

A.  H.  WRIGHT,  B.A.,  M.B.,  M.R.C.S.,  Esa.,  \ 
1.  H.  CAMERON,  M.B.,  ) 


\\ 


Ooyteultiny  Edlton, 


( 


Editor*. 


VOLUME   VII. 

JAJVUASr,  1883,  TO  DECEMBER,  1883. 


^'j>P^ 


J' 


TORONTO: 
GUARDIAN  BOOK  AND  JOB  PRINTING  HOUSE.  78  &  80  KING  STREET  EAST. 

1882. 


// 

^'7 


'* 


CONTENTS. 


A. 

Abscess  of  Liver,  Tropical,  195. 

Acne,  Treatment  of,  90.  , 

Aconite,  Poisoning  by,  47. 

Proper  Way  to  Give,  84. 

Address  to  Students,  335. 

Admonitory,  132. 

^Esthetics,  Medical,  71. 

Albumen  in  Urine,  New  Tests  for,  395. 

Albumen  Water,  82. 

Alum,  in  Lead  Colic,  381. 

Ambition  and  Liberality,  128. 

Amputations,  Subperiosteal,  302. 

Amyl  Nitrite,  Hypodermic  uses  of,  230. 

Anaemia,  Progressive  Pernicious,  300. 

Anaesthetic  Mixtures,  122. 

the  Safest  Known,  206. 

Anaesthetics,  Deaths  under,  238. 
Ani  Fissura,  397. 
Anatomical  Subjects,  202. 
Aiicurism,  Intrapericardial,  223. 

of  Thoracic  Aorta,  225. 

Anti-cancerous  Diet,  159. 
Anti-septic  dressing,  a  modified,  55. 

Midwifery,  165. 

Anti-spastic,  a  New,  373. 

Anus,  Congenital  Absence  of,  392. 

Aortic  Valvular  Disease,  389. 

Aphasia,  151. 

Aphthous  Fever,  Contagion  of,  328. 

Arsenic  in  Malignant  Lymphomata,  122, 

Archives  of  Dermatology,  406. 

Arteries,  Torsion  ot,  91. 

Ascites,  a  Case  of,  224. 

Association  Meetings,  The,  236, 

Astragalus,  Fracture  of  the,  231. 

Atropine  in  Cold  in  the  Head,  330. 

B. 

Bandages,  How  to  Remove  Plaster  of  Paris,  231. 

Beef-tea  and  Urine,  70. 

Bedsores,  Water  Bed  for,  70. 

Births,  Marriages,  and  Deaths,  36,  72,  108,  144,  214. 

248,  282,  316. 
Bladder,  Irritable  in  Women,  159. 

Wounds,  Treatment  of,  89. 

Blisters  in  Young  Children,  167. 
Boils,  Treatment  of,  54. 

Book  Notices,  36,  66,   103,  134,  178,  209,  241,  277, 

308,  337,  374,  408 
Boracic  Acid  in  Granular  Lids,  213. 

Skin  Diseases,  332. 

Boroglyceride,  206. 

Bougie,  Fiddle  String,  56. 

Bowel,  To  Determine  the  Direction  of  a  Loop  of,  301 . 

Brain,  a  Large,  213. 

Substance,  loss  of,  298. 

Bright's  Disease,  Acute,  181. 
Brine  Test  for  Albumen,  395. 
Buboes,  369. 

Abortive  Treatment  of,  199. 


Buboes,  Suppurating  Treatment  of,  199. 
Bullet  Wounds,  Treatment  of,  88. 


Calculus,  Rare  Case  of,  44. 

Canada  Medical  Association,  276,  204,  333. 

and  McGill  College,  372. 

Cancer  of  Stomach,  14. 

Precancerous  Stage  of,  49. 

Removal  of  Whole  Uterus  for,  95. 

Canities,  Sudden,  113. 

Carbolic  Acid  in  Whooping  Cough,  20. 

Cardiac  Typhoid,  368. 

Caruncle,  Urethral,  56. 

Cases  in  Practice,  148,  194. 

Catgut  Ligatures,  271. 

Cathartics,  Jisthetics  in,  281. 

Cervix  Uteri,  Laceration  of,  60. 

Charcoal  in  Eczema,  271. 

Chest,  Chronic  Diseases  of  the,  17. 

Chloral  in  Belladonna  poisoning,  117 

Action  on  Excretion  of  Sugar,  23. 

Poisoning  by,  49. 

in  Labour,  94. 

Chloralated  Tincture  of  Iodine,  91. 

Chloroform,  Emetic  and  Anthelmintic  Action  of,  155. 

Impurities,  12L 

Inhalations,  306. 

Chorea,  Salicylic  Treatment  of,  155. 

Christison,  Sir  Robert,  101. 

Chronic  Rheumatism  in  a  Dog,  155. 

Chrysophanic  Acid,  122. 

Cicatrices,  Treatment  of,  122. 

Circumcision,  Skillern  New  Forceps,  397. 

Citizens  of  Canada,  205. 

Clavicle,  Improved  Dressing  for  Fracture  of  the,  90. 

Clinical  Clerks,  205. 

Examinations,  275. 

Examination,  a  Model,  206. 

Lecture,  9. 

Teachings,  So-called,  204. 


Clubfoot,  55. 

Coca  Leaves  in  Painful  Afifection  of  the  Pharynx,  368. 

Code,  The  New,  214. 

Coffee,  A  Deodorizer,  300. 

Colleije,  Oatario  Veterinary,  99. 

Colon,  Malignant  Disease  of,  390. 

Comedo,  Pomade  in,  315. 

Conium  and  Curare,  Action  of,  117. 

proper  dose  of,  230. 

Consultations,  Freedom  of,  170. 

with  Homoeopaths,  61,  97. 

Consumption,  Contagiousness  of,  367. 

Treatment  of,  46. 

Convallaria  Majalis,  394. 

Copal  Varnish  in  Felon,  100.  / 

Copaiba  Balsam  in  Frostbite,  397. 

Corpus  Lnteum,  231. 

Correspondence,  28,  61,  96,  124,  167,  200,  232,  272,  804, 

Council,  Ontario  Medical,  98. 

Cricket,  248. 

Curare,  Artificial,  156. 


CONTENTS. 


Cyttitit,  90. 

CyBt  of  Pkncreu,  RemoTal,  121. 


Death,  Diagnosia  ot,  230. 
Dermatology,  Report  on.  382. 
DUbetM  Inaipidns,  Treatnieut  of,  47. 
Dtab«tic  Coma,  22. 

Neuralgia,  117. 

Digitalis,  Action  on  the  Heart,  21.  ^ 

Diphtheria,  351. 

Tannin  in,  47. 

Tracheotoinv  in,  59. 

Treatment  of,  153.  300. 

Sfquelre  of,  1. 

Diphtheritic  Croup,  Tracheoti^iuy  in,  I'.IJ. 
Disclaimer,  A,  133. 

Dislocation  of  Humerus,  Reduction  after  Five  Weeks, 
196. 

of  Radius  and  Ulna  Forwards,  112. 

Does  it  pay  t  174. 

Dover's  Powder,  350. 

Dressers,  Surjjical,  205. 

Druggist's  Mistake,  Death  from,  176. 

Dysentery,  Aconite  in  Acute,  268. 

Dyspepsia,  Cerebral  Symptoms  in,  23. 

K. 

Efirache,  200. 

ElbD^c,  C  implete  LatTal  Luxation  of,  301. 


:!^ 


Sanguineou'*  Deposits  in  the  Fold  of  the,  199. 
Empyema,  a  Case  of,  45. 

Treatment  of,  24. 

Entropion,  397. 

Epilep:>y,  Albuminuria  in,  48. 

Hamilton's  Mixture  for,  117. 

Epistaxis,  102. 

Epithelioma  of  Tongue,  Diagnosis  of,  118. 

Ergot,  a  More  Active  Form  of,  197. 

Ergot  in  Pertussis,  395. 

Erigeron  as  a  Haemostatic,  397. 

Ether,  Hvpodermically  in  a  Dynamic  Pneumonia,  48. 

PerUs  of,  122. 

Ethics,  Revision  of  Code  of,  108. 
Eucalyptus  Oil  in  Lumbago,  213. 
Examinations,  133. 

Medical  Council,  103,  172,  334. 

Results  of,  173. 

University,  63,  127. 

Eyes  of  New- Bom  Children,  95. 

F. 

F»ces,  Physical  Examination  of  the,  116. 

False  Membranes,  Difference  of,  198. 

Faradisation  of  Spleen  in  Intermittent  Fever,  197. 

Fat,  Chemical  Composition  of  the  Human,  154. 

Fees  for  Attendance  on  Garfield,  35. 

FeJon,  Abortive  Treatment  of,  100. 

Femur,  Sciatic  Dislocation  of,  with  Fractured  Ischium. 

296 
Fermentation,  Arrest  of,  231. 
Fever  Mixture,  Acid,  85. 
Fiddle-string  Bougie,  55. 
Fistula  in  Ano,  332. 
Forced  Feeding  in  Phthisis,  267. 
Fractured  Clavicle,  Improved  Dressing  for,  90. 
Fracture  of  Pelvis  and  Spine,  386. 
Frostbites,  Treatment  of^ Sequelae,  397. 

«. 

Gal vano- Cautery  in  Surgery,  239. 
Gastritis,  Diphtheritic  in  Pneumonia,  83 
Geikie,  Dr. ,  at  Trinity  Medical  School  Dinner,  38. 
Gelseminum,  Antipruritic,  198. 
in  Rhns  Poisoning,  263. 


Oenupectoral  position  in  Colic,  198. 

Glasgow,  Practitioners  of,  70. 

Glottis,  Oedema  of,  Treated  with  Pilocarpine,  49. 

Gonorrha-a,  801. 

Goitre,  Fluoric  Acid  in,  84. 

Gossypium  Medicatum,  395. 

Graduating  Class,  Address  to,  137. 

Guitcau's  Insanity  Plea,  63. 

Gynocardic  Acid,  332. 

H. 
Hasmonhoiiis.  Enuitation  as  a  I'levuiititive  of.  .^30. 

,  Forcible  Dilatation  of  Anus  in,  270. 

Surgical  Treatment  of.  199. 


Hsematocele,  Pelvic,  259. 
Hffimorrhagcs,  Erigeron  Internally  in,  397. 
Haemorrhage  into  Ventricles  of  Hrain,  116. 
Headache,  Potash  Iodide  in  Frontal,  268, 
Health  Bill,  103. 

Boards,  238. 

Provincial,  127,  211,  370. 

Secretaryship,  132. 

Chairmanship,  133. 

Hearing  in  School  Children,  95. 
H.ait,  A(  ute  Dilatation  of,  299. 
lltiut,  .\uiiic  Disease  of,  389. 

Disease,  with  Rheumatism,  292. 

Iodide  and  Bromide  of  Potash  in,  20. 

Hydatid  Cyst  of,  330. 

Helenine.  Antidote  to  Tubercle,  395. 
Hernia,  Reduction  of  old,  270. 
Hiccough,  Long  Duration  of,  117. 
Hip-joint  Amputations,  332 

Dislocation  of.  366. 

HomcBopaths  in  the  Medical  Council,  203. 

Homoeopathy,  Dr.  0.  W.  Holmes  on,  282. 

Hospital  Notes,  41,  223. 

Hospital  Staff  Representation  of  the  Schools  and  i'ro- 

fessions,  404. 
Hotels,  Canadian  and  American,  406. 
Humerus,  Manipulation  in    Reduction  of  Dislocation 

of,  56. 

Dislocation,  Reduction  after  Five  Weeks,  196. 

Hunyadi  .lanos  Water,  Artificial,  23. 

Hutchinson's  Advice,  406. 

Hydatids  of  Liver,  Cure  by  Calcareous  Degeneration 

of  Cyst,  260. 
Hygiene,  International  Congress  of,  369. 
Hygienic  Measures,  180. 
Hypodermic  Injections,  198. 


Ileus  from  Shellac  Concretions,  330. 

Innominate,  Ligature  of  the,  .301. 

Insanity,  Tests  of,  85. 

Insecticide  Lotion,  280. 

Intestinal  Obstruction,  Unusual  Case  of,  109. 

Massage  in,  315. 

Intra-cranial  Tumours,  21. 
Intrafoetation,  200. 
Introductory  Lecture,  376,  380. 
Iodine,  Chloralated  Tincture  of,  91. 

Injections  in  Lymphoma,  231. 

in  Urine,  Test  for,  315. 


Iodoform  Dressings,  87. 

in  Eczema,  91. 

Iodoform  in  Eye  Disea.se,  396. 

in  Diabetes  Mellitus,  230. 

Ischium,  Malignant  Disease  of,  13. 

J. 

Jubilee  of  McGill  College  Medical  Faculty,  382. 

K. 
Kidney,  Amyloid,  without  Albuminuria,  267. 

Tumours,  49. 

Koch's  Bacillus  of  Tubercle,  266,  268. 


CONTENTS. 


Labour,  Chloral  in,  94, 

Laceration  of  Cervix,  Emmet's  operation  for,  164. 

Lachrymal  Sac,  Incision  of,  27. 

Landmark,  Collapse  of  an  Ancient,  91. 

Lead  Colic,  300. 

Leprosy  in  Cape  Breton,  15. 

Libel  Suit,  371. 

Lingual  Tourniquet,  158. 

Lister's  Dressing,  a  Modification  of,  55. 

Lithotomy,  a  Complication  of,  55. 

Liver  Abcess,  Treatment  of,  158. 

Fatty  Degeneration  of,  366. 

Suppumting  Cyst  of,  Cured  by  Single  Puncture, 

88. 
Locomotor  Ataxy,  Stretching  of  Right  Sciatic,  251. 
Lumbago,  Eucalyptus  Oil  in,  213. 
Lupus  Vulgaris,  Iodoform  in,  27. 

n. 

Maggots  in  Unusual  Situations,  372. 
Malarial  Fevers,  Sulphur  Emanations  in,  394. 
Malaria  and  Skin  Diseases,  404. 
Malpractice  Suit,  174. 
Manufacturing  Doctors,  175. 
Measurements  in  Surgery,  294. 
Medical  Colleges,  213. 

Council  Examiners,  204. 

Meeting,  235,  241. 

of  Ontario,  130. 

Medical  Department  Westei-n  University,  276. 

Library,  64. 

Society  Meetings,   36,  69,  105,  136,  210,  245, 

279,  309,  339. 

of  New  York,  143. 

of  Toronto  School  of  Medicine,  34,  62,  101,  132, 

402. 
Medicine,  Report  on,  322. 
Medicus  and  Medical  Schools,  131. 
Milk  Diet  in  Bright's  Disease,  85. 
Moral  Insanity,  81. 

Morbilli  and  Vaccinia  Concurrent,  111. 
Murchison  Scholarship,  206. 
Museum,  An  Annual,  276. 
Myxoedema,  46. 

ST. 

Nails,  Loss  of  in  Ataxy,  155. 
Naphthol  in  Skin  Disease,  397. 
Narcotics  and  Responsibility,  316. 
Necrosis  of  Cranial  Bones,  77. 
Nerve  Stretching  in  Sciatica,  91 . 

119. 

Neurosis,  Painful  Pressure-points  in,  393. 

Newspaper  Offences  against  the  Profession,  100,  131. 

Nicotinism,  117. 

Nipples,  Sore,  302. 

Nitrite  of  Amyl,  Antidote  for  Strychnia,  166. 

in  Hour  Glass  Contraction  of  Uterus. 

167. 
Nitro-Glycerine,  Therapeutic  uses  of,  84,  154. 

Toxic  Effects  of,  45, 

in  Toothache,  48. 

Nose  and  Throat,  Mistakes  to  be  Avoided  in  Diseases 

of,  355. 
Nurses"  Directory,  399. 

O. 

Obituary,  101,  144,  177,  209,  239,  308,407. 
Obstruction,  An  Unusual  Case  of  Intestinal,  109. 

Early  Treatment  of  Prostatic,  158. 

(Edema  Localized,  329. 

Old  Age,  316. 

Olecranon  Epiphysis  Separation  of,  297. 

Oleoze,  156. 


Ontario  Medical  Association,  201,  204, 

Ophthalmia  Neonatorum,  27,  303. 

Ophthalmology,  Points  of  General  Interest  in,  188,  217, 

253. 
Ophthalmology  and  Otology,  Report  on,  383. 
Optic  Nerve,  Stretching  of  the,  301. 
Orchitis,  269. 
Orthopsedic  Lectures,  406. 
Our  Contemporary,  237. 
Out  Patient  Departments  of  Hospitals,  274. 
Ovaiiotomy,  185. 

Death  from   Preliminary  tapping  in,  123. 

Practical  Observations  on,  160. 

Statistics  of  Thirtv-two  Consecutive  Cases 


of,  124 
Ovary,  Hernia  of,  298. 
Oxygenated  Water  in  Surgeiy,  331. 

P. 

Pancreas,  Successful  Removal  of  Cyst  of,  121. 
Papaya  in  Diphtheria,  156. 
Parsley  as  an  Antigalactogogue,  27. 
Patella,  Fracture  of,  156. 
Pelvis,  Fracture  of,  386. 
Perineum,  Prevention  of  Rupture  of,  60,  167. 
Periostitis  Alveolar  in  Diabetes  Mellitus,  84. 
Peritonitis,  Acute,  in  Children,  48. 
Treatment  of,  262. 


Personals,  64,103,  176,  207,  276,  307,  337,  373,  407. 
Pharmacy,  Ontario  College  of,  134. 
Phthiriasis,  from  Hen  Lice,  23. 
Phthisis,  A  Case  of  Acute,  221. 

Antiseptic  Treatment  of,  325. 

Physicians,  Their  own  Photographers,  102. 
Picric  Acid  Test  for  Albumen,  395. 
Pilocarpine,  in  (Edema  Glottidis,  49. 
Pleural  Injections,  Risks  of,  53. 
Pneumonia,  Diphtheritic  Gastritis  in,  83. 

Treatment  of  some  forms  of,  115. 

Pork  Measle  in  Man,  330. 

Poroplastic  Jacket  in  Spinal  Curvature,  54. 

Potassium,  Chlorate  and  Chloride,  300. 

Precancerous  Stage  of  Cancer  and  Early  Operations,  49. 

Prescriptions,  Percentages  on,  305. 

Pressure-points  Painful  in  Neuroses,  393. 

Procidentia  of  the  Gravid  Uteras,  150,  167. 

Prostatic  Obstruction,  Early  Treatment  of,  158. 

Pseudo-hypet trophic  Muscular  Paralysis,  II. 

Puerperal  Convulsions,  Amyl  Nitrite  in,  166. 

Eclampsia,  Etiology  of,  303. 

Infection,  Prevention  of,  332. 

Pulse,  Method  of  Counting  a  Rapid,  315. 
Slow,  70,  226. 

Quackery,  Ancient  and  Modern,  71. 
(Quinine  in  Obstetrics  and  Gynaecology,  92. 
To  Hasten  the  Action  of,  156. 


Railway  Accidents  First  Aid,  406. 

Rectum,  Congenital  Deformity  of,  392 

Rectum,  Malignant  Disease  of,  .390. 

Rectum,  Sloughing  of.  111. 

Register  for  Nurses,  64. 

Registrable  Qualifications,  405. 

Repair  of  Wounds  Delayed  by  Venereal  Act,  102. 

Respiration  Abnormal,  868. 

Rheumatic  Purulent  Conjunctivitis,  156. 

Rheumatism,  Acute  with  Acute  Endo-pericarditis,  229. 

Rhus  Poisoning,  Gelseminum   n.  263. 

Ring  Worm  of  Scalp,  300. 

Rough  on  Rats,  Composition  of,  398. 

Rotheln,  205,  265,  297. 

Rupture  of  Uterus,  80, 


CONTENTS. 


Salicylic  Acid  in  Tineee,  231. 

Salivary  Fistula,  New  Method  of  Treating,  301. 

Srtnitary  Convention  at  St.  Thomas,  344. 

School  Children,  Hearing  in,  95. 

Schools,  Union  of  the  Toronto,  398. 

Unification  of,  403. 

Closure  of,  for  Zymotic  Disease,  414. 

Sciatica,    Xerve  Stretching  in,  91,  301. 

Diagnosis  of,  302. 

Sea-sickness,  369. 

Sequestra,  Absorption  of,  271. 

Session,  A  Summer,  401. 

Severe  Falls  without  loss  of  Consciousness,  16. 

ShouMer  Dislocation,  Reduction  of,  388. 

Kocher's  Method,  388. 

Keliey's  Method,  388. 

Shoulder,  Reduction  of  Old  Standing  Dislocation    of 

122. 
Signs,  Doctor's,  306. 
Skin  Giijfting.  91. 

Skull,  New  Method  of  Trephining,  86. 
Smallpox  in  Birds  and  Poultr)-,  281. 
Snake,  The  Man,  282. 
Spleen,  Spontaneous  Rupture  of,  869. 
Splenic  Pulse,  176. 

Spinal  Cord,  Preparation  of,  for  Microscopical  Sections, 
85. 

Curvature,  A  Case  of,  193. 

Poropla.stic  Jacket  in,  54. 

Spine,  Fracture  of,  386. 

Sponges,  Cleaning  of,  26. 

Sponge-Dressing,  296. 

Sprain  Ju.xta-epiphyseal,  269. 

Sputum,  Signiticance  of  Alveolar  Epithelium  in,  300. 

Still-born,  Treatment  of  the,  303. 

Stomach,  Cancer  of  the,  14. 

Rupture  of,  391. 

Stricture  of  Descending  Colon,  Excision  of,  157. 
Strumous  Glands,  Treatment  of,  271. 
Students  and  Police,  34. 
Suicide,  Novel  Method  of,  236. 

Singular,  248. 

Supra-Renal  Capsules,  Malignant  Disease  of,  390. 

Surgery,  Report  on,  317. 

Syphili.s,   Ammonio  Mercuric  Peptones  iu,  332. 

Bacteria  of,  367. 

Syphilitic-Laryngitis,  27. 

T. 

Taenia  Multiple,  85. 

Teeth,  Temporary  Treatment  of  Caries  of,  396, 

Telegram  Tattle,  213. 

Telephonic  Troubles,  213. 

Temjwrature  in  Child  Bed,  93. 

Central  Nervous  AflFections,  299. 

Tetanus  Traumatic  from  Vaccination  and  Death  from. 

198. 
Then  and  Now,  94. 
Therapeutic  Memoranda,  281. 
Therapeutics  and  Phannacology,  Notes  on,  5,  73.  145 

215,  286,  359. 


Tinea  Kerion,  388. 

Tinea  Versicolor.  Annular,  91. 

Tonsilliti.s,  Soda  Bicarbonate  in,  48. 

Tonsillotomy  with  Hosmorrhage,  249. 

Tongue  Epithelioma  of,  81. 

Toothache,  10,  48. 

Toronto  School  of  Medicine  Annual  Dinner,  400. 

Torsion  of  Arteries,  91. 

Torticollis,  Resection  of  Spinal  Accessory  in,  90. 

Tracheotomy  in  Diphtheria,  69. 

in  Diphtheritic  Croup,  192. 

Trachelorrhaphy,  289. 

Trichinosis,  364. 

Tribunal,  A  Medical,  102. 

Trinity  School  of  Medicine  Annual  Dinner,  402. 

Trophic  Nerves  and  Nerve  Centres,  85 

Tubercle,  113. 

Hyaline,  115. 

Tuberculosis,  .327,  403. 

Turpentine,  Administration  of,  85,  266. 

Tympanism,  Subclavicular,  329. 

Typhoid  Fever,  Causes  of,  37. 

. Ergot  in,  330. 

IJ. 

University  of  Toronto,  Results  of  Examinations,  208. 
I Trinity  College  Convocation,  208. 

Victoria  College  Convocation,  208 

I  Unpaid  Service,  Limits  of,  130. 
j  Unprofessional  Advertising,  64. 
I  Uraemia,  Pathology  of,  82. 
I  Urinary  Sediments  Crystalline,  264. 

Urine,  Disinfection  of^  307. 

Incontinence  of  in  Children,  124. 

Uterine  Displacements,  58. 
j  Uterus,  Accidental  Removal  of,  Recovery,  .302. 

Removal  of  Fibro-cy.stic  Tumour  of,  293 

Rupture  of,  80. 

Vaccination.  Tetanus  from,  198. 
Vaccine  Virus,  New  Source  of,  143. 

I Proper  Mode  of  Preserving,  150. 

Vaginitis,  Formula  for,  302. 
Variola,  and  M.  Pennes'  Antiseptic,  265. 
Venesection  in  Convulsions,  288. 
Veterinary  College  Dinner,  64. 

—  of  Ontario,  99. 

Viability  of  Premature  Children,  272. 

Victoria  College  University,  134. 

Viola  Tricolor  in  Chronic  Eczema,  110. 

Virginia,  Univer,«itv  of,  303. 

Vision,  Causes  and  Consequences  of  Defective,  283. 

W. 
Watson,  Sir  Thomas,  405. 
Western  Farming,  65. 
Whooping  Cough,  The  Nerve  Element  in,  83. 

Carbo'ic  Acid  in,  20. 

Wool  Prepared  and  Medicated,  395. 
Wounds,  Absorption  from,  53. 

of  Bladder,  Treatment  of,  89. 

Bullet,  Treatment  of,  88. 


TH  E 


A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


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TORONTO,  JANUARY,  1882. 


(DrioiHivl  (iJommunintticmsi. 

THE  SEQUELS  OF  DIPHTHERIA.  . 

BY    R.    W.    POWELL,     M.D.,    OTTAWA. 

(Read  before  the  Ottawa  Medico  Chirurgical   Society, 
25th  Nov.  1881.) 

[After  a  citation  of  experiments  demon- 
strating the  inoculability  of  diphtheria  from 
the  pseudo-membrane,  Dr.  Powell  continued : — ] 

The  sequelse  of  diphtheria  ai'e  of  a  very 
important  character,  and  have  long  been  ob- 
served. They  were,  we  may  say,  among  the 
first  peculiarities  that  stamped  this  as  a  S})ecial 
disease,  due  to  a  specific  morbid  poison  which 
reproduced  itself  and  nothing  else.  They 
were  not  found  following  other  diseases  of  the 
throat,  nor  do  some  of  theim  occur  after  any  of 
the  other  diseases  of  the  zymotic  class,  and  are 
sufficient,  to  my  mind,  to  enable  us  to  place 
this  disease  among  the  general,  as  distinguished 
from  the  local  disorders.  They  are,  further- 
more, of  importance,  as  they  cannot  be  fore- 
told ;  and  the  mildest  case  of  diphtheria  is  apt 
to  become  serious  from  their  occurrence. 

Among  them  we  have  albuminuria,  asthenia, 
cardiac  thrombosis,  acute  nephritis,,  and  par. 
alysis. 

Albuminuria,  though  often  more  a  com- 
plication than  a  sequel,  is  of  importance  as 
affording  an  indication  for  treatment,  and  may 
be  taken  up  in  this  connection;  and  also 
because  though  usually  beginning  during  the 
course  of  the  disease,  yet  will  continue  for  a 
long  time  after  it.  producing  a  true  anaemia. 

As  I  say,  it  usually  comes  on  early  in  the 
disease,  and  was  noticed  as  a  concomitant 
symptom  of  this  peculiar  throat  lesion  as  early 


as  the  year  1857.  The  quantity  varies  greatly 
in  diff"erent  cases  from  a  mere  trace  to  a 
sufficient  amount  to  render  the  urine  semi- 
solid on  boiling.  Strange  to  say,  however,  the 
quantity  of  albumen  present  in  any  given  case 
does  not  afford  a  true  or  positive  indication  of 
the  severity  of  the  attack  ;  it  often  being  in 
large  quantities  in  tolerably  mild  cases  and 
vice  versa;  but  the  long  continued  presence 
of  albuminuria  is  of  grave  significance  as 
regards  a  favourable  prognosis,  not  alone  as 
indicating  any  serious  condition  of  kidney  dis- 
organization, but  because,  as  I  hinted  before, 
the  continued  and  prolonged  drain  of  albumen 
from  the  blood  produces  an  anaemic  condition, 
which  seriously  retards  recovery. 

The  albumen  is  often  of  hsemic  origin  as 
well  as  from  diseased  kidneys,  and  this  will 
account  for  the  fact  that  even  when  albumen 
is  being  given  off*  in  large  quantities  yet  dropsy 
may  be  absent  and  no  symptom  of  ursemic 
poisoning  present,  because  no  obstruction  exists 
to  the  elimination  of  urea.  In  many  such 
cases  as  much  as  600  gr.  of  urea  being  elimin- 
ated in  twenty- four  hours,  i.e.,  three  times  the 
normal  amount. 

When  of  nephritic  origin,  and  accompanied 
by  smoky  urine  and  casts  and  deficient  urea, 
then  it  is  more  serious  as  indicative  of  struc- 
tural disorder.  I  said  it  is  often  of  hsemic 
origin,  and  this  I  infer  from  the  fact  that 
at  autopsies  of  cases  where  large  quantities 
of  albumen  were  given  off",  the  kidneys  were 
only  moderately  congested,  or  only  to  an 
extent  we  would  reasonably  expect  in  a  case  of 
blood  poisoning  of  such  a  nature  as  diphtheria- 
On  I  he  other  hand,  serious  kidney  trouble  will 
occur,  accompanied  by  general  anasarca,  as  I 


2 


CANADIAN  JOURNAL 


oli8fi-ve«l  ill  a  recent  c«8»'7  and  uiuieDver, 
M.  Wade  reports  a  ca«e  where  death  occurred, 
and  an  autopsy  was  performed  on  seventh  day. 
Here  he  found  a  large  while  swollen  kidney, 
as  in  scarlatinal  ne])hritis. 

As  regards  albuminuria  as  a  prognostic  sign, 
some  diflFerence  of  opinion  seems  to  prevail ; 
but  what  I  have  given  you  srems  to  be  the 
general  opinion.  Still,  we  have  Flillier  stating 
he  examined  thirty-eight  cases  in  regard  to 
this  jx)int,  and  found  albumen  present  in 
thirty-three  and  absent  in  five.  Of  the  thirty- 
three  albuminous  cases  thirty-two  died  (cause 
of  death  not  given),  and  the  five  non-albumin- 
ous recovered. 

Trousseau  and  Morell  Mackenzie  both  look 
upon  it  as  an  uncertain  prognostic  sign  and 
that  it  has  only  a  limited  significance.  Other 
authors  seem  to  dismiss  the  whole  matter  in  a 
few  words,  and  El)erth  thinks  that  the  quantity 
of  albumen  is  usually  proportionate  to  th«! 
severity  of  the  case. 

Asthenia. — Any  one  who  has  be«?n  actively 
engaged  in  treating  diphtheria  will  havn 
noticed  from  the  very  firat  the  peculiar  con- 
dition of  depression  ptesentfd  by  the  patient, 
and  this  in  mild  as  well  as  severe  cases.  It 
does  not  appear  to  be  the  same  state,  as  will 
be  observed  after  ordinary  pyrexial  conditions, 
because,  as  I  say,  it  will  be  noticed  from 
the  very  outset.  The  listless  appearance,  dis- 
inclination for  movement,  heavy  eyelids,  stupid 
expression,  etc.,  are  nearly  characteristic. 
There  is  from  the  outset  a  tendency  to  death, 
and  it  will  not  do,  at  all  events  in  this  disease, 
to  sit  by  and  content  ourselves  with  watching 
the  course  of  the  symptoms  and  guiding  the 
attack.  Something  more  active  is  imperativelv 
demanded  from  us,  and  we  are  botmd  in  my 
opinion,  to  warAofi"  the  asthenia.  If  we  have 
nothing  else  to  attack  in  the  way  of  ccinplica- 
tion,  such  as  a  croup,  haemorrhage,  nephritis, 
delirium,  etc.,  we  always  can  do  battle  against 
the  asthenia. 

As  to  what  this  condition  is  due  to  we  do 
not  know,  but  it  would  seem  to  b;  the  efft-ct  of 
the  poison  on  the  central  nervous  system,  both 
brain  and  cord.  It  is  not  a  muscular  weakness 
as  after  pyrexia,  nor  is  it  due  to  failure  in 
the  circulation ;  but  it  seems  to  be  coincident 


with  the  pr  seuce  of  the  diphiian-iiic  p  )ison 
in  the  system.  It  is  part  and  parcel  of  the 
disease. 

Peter  Eade,  as  early  as  1859,  calls  attention 
to  thi*-  very  point,  and  observes  that  in  some  of 
these  cases  it  approaches  pure  asthenia  more 
than  anything  he  had  ever  previously  wit- 
nessed. The  appropriate  therapeutics  will 
occur  to  you  if  this  reasoning  is  correct,  and 
I  for  one  consider  alcoholic  stimxilation  a 
necessary  factor  in  the  succes-sful  treatment 
of  this  affection.  Not  that  cases  will  not 
recover  without  it,  but  by  witliholding  it, 
I  consider  we  deprive  the  patient  of  one 
powerful  means  of  preventing  perhaps  a  fatal 
issue  after  his  apparent  recovery. 

Don't  let  us  wait  to  fight  the  asthenia  when 
it,  comes  on  unpleasantly  fast,  but  let  us  fortify 
the  system  against  its  occurrence.  1  believe 
death  will  occur  from  this  sequel  alone  without 
any  other  factor. 

I  was  called  to  see  M.  M ,  aet.  11  years, 

male,  on  Nov.  17,  1881.  Had  a  seveie  attack 
of  diphtheria,  beginning  nineteen  days  before ; 
said  to  have  been  unusually  severe,  with  much 
swelling  of  glands  of  neck,  difficulty  of  swal- 
lowing, etc.  When  I  saw  him  he  appeared 
greatly  exhausted,  pale,  and  refused  nourish- 
ment ;  occasional  vomiting,  especially  after 
milk  ;  speech  distinctly  nasal ;  complained  of 
epig>i8tric  weight,  and  a  feeling  of  sinking. 
On  feeling  the  pulse  I  was  at  once  struck 
with  its  remarkably  slow  action.  It  was  quite 
regular,  but  had  a  distinct  interval  between 
each  pulsation.  On  counting  it  several  times, 
so  as  to  make  hure,  I  found  only  twenty-six 
beats  per  minute.  It  felt  simply  as  if  the 
heart  was  tired  out,  and  so  it  proved,  because 
any  treatment  was  now  of  no  avail ;  and 
though  he  continued  to  take  a  little  fluid 
nourishment,  spoke,  and  said  he  felt  getting 
better,  he  gradually  sank  and  died  three  hours 
after  mj  visit.  It  may  be  interesting  to 
mention  that  the  gentleman  who  attended 
during  the  illness  recommended  that  no  siimu- 
lants  be  given. 

Called    to    see   J.   B ,    male,    aet.    \&,    a 

strong,  healthy  young  man,  Oct.  18,  1881.  I 
*vas  attending  m  case  of  catarrhal  nephritis 
in  the  house  at  the  time  (the  child  of  another 


O^  MEDICAL  SCIENCE. 


person),  and  was  asked  to  see  this  case.  It 
had  being  going  on  for  two  days,  biit  the 
mother  had  some  soveieign  remedy  of  '.ler  own 
and  thought  she  could  manage  it  alone.  I 
found  the  boy  with  a  very  severe  attack — high 
fever,  bounding  pulse,  throat  much  swollen, 
and  glands  of  neck  standing  out  in  a  bunch  as 
big  as  my  fist  on  either  side ;  tongue  swollen 
and  having  a  thick  fur,  saliva  running  from 
the  mouth  ;  uvula,  soft  palate,  tonsils  and 
pharynx  one  complete  mass  of  disease,  and 
an  exceedingly  offensive  stench  from  the 
breath.  I  put  him  under  treatment  by  iron 
potass,  chlor.  and  lime  water,  both  as  a  gargle 
and  to  take  internally,  and  added  brandy  as  a 
regular  part  of  the  treatment.  I  had  not 
previously  attended  this  family,  and  simply 
saw  the  case  as  I  was  in  the  house.     Two  days 

after,  I  met  the  regular  attendant,  Dr.  F , 

and  we  both  thought  the  case  one  of  great 
peril.  I  found  he  had  not  used  the  remedies  I 
left'and  refused  stimulants.  During  the  next 
two  weeks  I  was  visiting  quite  close  to  this 
house,    and    heard    from    time    to    time    that 

J.  B was  ])rogre!;sing  favourably,  and,  on 

my  last   inquiry,   I    learned    that  he    was    up 
and  had  been   out  as  far  as  the  barn.     They 
did   not   ask   me  to   see   him,  so   I   supposed 
Dr.    F continued    in  attendance.       How- 
ever, it  turned  out  that  they  continued  treat- 
ment  as   best   they  could   with  the   remedies 
we  had  prescribed,  and  neither  of  us  watched 
the    case.      They    had    great    difficulty,   as   is 
commonly  the   case,  in    getting    him    to    take 
proper    or    sufficient    nourishment,    and     the 
stimulants  he  declined,  and  I  suspect  they  were 
never   pushed.     Three    weeks   from    the   time 
of  my  first  visit,  i.e.,  Nov.   8th,  they  came  for 
me  again,  saying  he  was  very  ill.     I  declined 
going  at  first,  on  the  ground  that  I  could  take 
no  responsibility,  as  I  had  not  the  opportunity 
of    directing   treatment   during   convalescence, 
and    I   had   a   suspicion   as  to  how   I    would 
find  him.     They    pressed  me,  however,  and  I 
finjtUy   yielded.      I   found   him   lying   down ; 
voice  weak ;    looked   pale ;    muscular    system 
flabby ;    short    cough  ;    voice,    nasal    slightly  ; 
restless ;    vomiting    and    feeling   of    profound 
depression  referred   principally  to  the  cardiac 
region ;  would  take  no  solid  food,  and  liquids 


constantly  returned ;  throat  quite  well,  but 
distinct  paralysis  of  soft  palate,  and,  from  the 
difficulty  of  swallowing,  I  should  judge  also  of 
the  pharynx  ;  pulse,  soft  and  compressible  and 
about  normal,  or  if  anything  slower.  He  was 
drowsy.  I  hoped  he  might  rally,  and  I  put 
him  on  appropriate  treatment  ;  but  he  gradually 
sank  and  died  two  and  a  half  days  after  I 
saw  him  and  before  my  next  summons.  This 
man,  in  my  opinion,  reduced  his  chances  and 
even  caused  his  death  by  refusing  stimulants. 
Of  course,  no  one  was  by  to  press  them. 

Cardiac  Thrombosis. — This  fatal  sequel  has 
been  noticed  frequently  after  diphtheria,  but 
cannot  be  said  to  be  peculiar  to  this  disease 
Several  factors  may  be  responsible  for  its 
occurrence,  and  probably  ail  combine  to  pro- 
duce the  fatal  result.  The  blood  itself  is 
gradually  brought  into  a  condition  favourable 
for  coagulation  by  the  pyrexia,  and  it  may 
have  some  special  chemical  ingredient  altered 
in  this  as  well  as  other  of  the  blood  diseases, 
whereby  the  fibrine  more  easily  forms,  because 
it  is  not  now  thought  to  exist  as  such  in  the 
circulating  fluid ;  and  then,  again,  we  have  a 
condition  of  heart  favourable  to  retardation  of 
fluid  circulating  in  it,  as  well  as  sometimes 
actiial  inflammation  of  the  endocardium. 

The  symptoms  of  this  are  said  to  be  pre- 
cordial distress,  anxiety  of  countenance,  great 
restlessness,  pallid  surface  with  cold  sweats,  and 
a  sense  of  impending  death.  Its  rapid  onset 
and  fatal  consequence  render  it  one  of  the 
most  frightful  of  the  sequelae.  The  pulse  is 
also  soft  and  irregular,  and  usually  very  rapid 
and  often  a  heart  murmur. 

To  prevent  such  a  condition,  I  should  think 
the  indication  would  be  to  support  the  failing 
heart ;  to  keep  the  blood  as  pure  as  possible, 
by  seeing  that  the  excretory  organs  were  in 
proper  action ;  to  keep  the  blood  also  well 
supplied  with  fluid  ;  and  to  administer,  if  neces- 
sary, ammonia. 

Acute  Nephritis. — This  sequel  has  been  ob- 
served in  connection  with  diphtheria,  but  in 
far  less  frequency  than  after  scarlatina.  The 
occurrence  of  nephi-itis  at  one  time  caused 
the  belief  that  the  poisons  of  the  two  diseases 
just  mentioned  were  alike.  This,  however,  is 
not  so.     It  was  observed  to  follow  diphtheria 


CANADIAN  JOURNAL 


as  early  as  1857,  i.e.,  when  this  disease  waK 
under  close  observation,  and  a  case  of  death 
with  general  anasarca  is  rej)orted  in  the  Lancet 
of  that  year.  The  cause  of  it  is  probably  the 
same  as  scarlatinal  nephritis — cold  acting  on 
an  already  irritated  kidney.  But  cases  occur 
where  every  precaution  is  taken,  and  it  seenjs 
to  be  due  to  the  actual  violence  of  the  poison 
acting  on  fine  kidney  structure  during  its 
pa8i>age  from  tbe  body,  and  also  probably  it 
has  a  special  affinity  for  kidney.  The  symptoms 
I  need  not  detail  to  you,  nor  need  we  discuss 
the  treatment. 

I  was  asked  to  see  a  little  boy  of  Mr.  B , 

set.  9  years,  on  Oct.  9th,  1881.  The  child  had 
just  recovered  from  an  attack  of  diphtheria. 
One  brother  had  died  of  it  at  the  same  time, 
and  while  I  was  attending  this  boy  I  saw  the 

case  of  J.  B just  related.     Besides  this,  his 

speech  was  distinctly  nasal  and  he  was  very 
weak,  as  evidenced  by  paleness  and  loss  of 
muscular  power.  He  had  quite  recovered  the 
throat  lesion.  I  found  him  chilly  and  miser- 
able. He  complained  of  headache,  pain  at  the 
xiphoid  cartilage  and  in  epigastrium,  for  which 
mustard  had  been  applied  and  had  given  hira  re- 
lief. His  bowels  were  confined  and  urine  scanty, 
and  I  could  not  obtain  a  specimen.  He  was 
coughing ;  pulse  small.  I  gave  him  a  purge  and 
an  expectorant.  Sent  for  again  in  four  days. 
He  was  still  coughing  and  the  expectoration  was 
well  established.  There  was  oedema  ol  base  of 
lungs ;  general  anasarca  was  also  present,  but 
moderate ;  his  urine  high-colored,  scanty,  and 
albuminous  but  to  a  moderate  extent.  I  now 
changed  the  treatment  and  gave  him  pulv, 
jalap.  CO.  and  cream  of  tartar  each  night,  an 
extra  blanket,  purely  milk  diet,  and  a  mild  dia- 
phoretic and  diuretic  mixture.  In  four  days 
more  the  dropsy  gradually  subsided,  and  was 
coincident,  of  course,  with  free  purgation  and 
re-establi^hment  of  the  secretion  of  urine. 

By  Oct.  20,  all  oedema  had  completely  gone, 
and  he  gradually  returned  to  full  diet;  was 
Boon  iip  and  about,  and  "began  then  a  mixture 
of  tincture  of  iron.     No  uraemic  symptoms. 

I'aralysis. — We  now  come  to  the  must  pe- 
culiar of  all  the  sequelae,  but  fortunately  one 
that  is  not  by  any  means  necessarily  fatal  nor 
even  prolonged,  usually    not    extending  much 


beyond  controllable  limits  and  amenable  to 
treatment.  Still,  wh(ai  present,  it  is  the  cause 
of  veiy  disagreeable  sensations,  interfering 
often  with  the  function  of  the  special  senses^ 
and  with  deglutition,  respiration,  and  cir- 
culation. 

The  exact  cause  of  this  lesion  is  not  de- 
termined, as  far  as  I  am  aware,  but  the 
prevailing  opinion  seems  to  be  that  it  is  a 
change  whicli  occurs  primarily  in  the  part 
affected  by  the  local  lesion  of  diphthr.ria;  and 
certain  it  is  that  the  vast  majority  of  cases 
agree  to  this  theory,  because  they  principally 
are  connected  with  the  nerve  supply  of  the 
throat  and  adjacent  parts.  The  pneumogastric 
nerve  seems  to  be  often  affected,  and  the 
paralysis  will  sometimes  extend  to  nearly  all 
parts  which  receive  their  supply  from  it — the 
pharynx,  the  larynx,  the  bronchi,  the  stomach, 
the  heart,  and  so  on — and  thus  we  have 
vomiting,  death  from  suffocation,  owing  to  the 
rim  a  glottidis  allowing  foreign  bodies  to 
enter  larynx,  being  deprived  of  its  sensibility ; 
dysphagia  and  regurgitation  of  food  and  liquids 
into  the  mouth  and  nose,  owing  to  the  non- 
action of  the  velum  and  uvula.  As  to  the  heart 
affections  there  is  some  doubt,  because  the 
pneumogastric  filaments  are  known  to  act 
as  depressors,  and  paralysis  of  them  ouglit 
to  have  a  stimulating  effect  on  the  heart.  StiJ'. 
the  morbid  influence  may  be  in  the  sympathetic 
filaments  in  the  same  nerve  and  which  act 
in  an  opposite  way.  The  glosso-pharyngeal  is 
also  imjdicated,  as  known  by  loss  of  sensation 
in  parts  supplied  by  it.  The  disturbance  of 
sight  is  due  to  paralysis  of  ciliary  muscle  and, 
consequently,  loss  of  accommodation. 

This  can  be  rectified  artificially  by  convex 
glasses  of  suitable  strength  till  the  nerve  power 
is  restored.  The  deafness  is  most  likely  due 
to  paralysis  of  the  very  muscles  we  have  been 
speaking  of  in  the  pharynx,  whereby  the 
opening  of  the  eustachian  tube  is  rendered 
of  no  service  and  the  same  effect  is  produced 
as  in  cases  of  relaxed  sore  throat  and  granular 
pharyngitis,  though  from  a  diffei*ent  cause,  no 
communication  being  possible  between  the  air 
on  either  side  of  the  drum  membrane. 

This  paralysis  will  occasionally  extend  to 
other  nerves,  and    even   produce   the   various 


OF  MEDICAL  SCTENCE. 


lesions  due  to  paralysis,  from  nasal  speech 
to  hemiplegia.  The  immediate  cause  we  can- 
not say,  but  there  is  good  reason  to  suspect 
that  the  whole  trouble  is  not  only  local  and 
produced  by  the  poison  in  the  terminal  ends 
of  the  nerves,  but  is  partly  due  to  the  action 
of  this  poison  on  the  central  nervous  system 
through  the  blood,  as  I  mentioned  before  when 
speaking  of  asthenia. 

However,  were  this  the  actual  cau.se  of  the 
paralysis,  it  would  probably  be  more  persistent 
when  once  it  occurs  than  it  really  is.  Might 
we  not  have  both  causes  acting  together 
to  produce  this  result :  the  dyscrasia  of  the 
blood  reducing  the  supply  of  food  to  the 
central  nervous  system,  thereby  rendering  it 
more  liable  to  attacks  upon  its  integrity ; 
the  exciting  cause  being  the  local  disease  acting 
on  the  terminal  fibres  of  the  nerves  and  then 
the  lesion  gradually  extending. 

On  this  theory  we  must  take  it  for  granted 
that  nerves  will  conduct  morbid  processes 
as  well  one  way  as  another,  i.e.,  sometimes 
op}>osite  to  their  ordinary  mode  of  conducting 
impressions.  T^^is  is,  I  think,  already  granted. 
To  show  clearly  that  the  local  disease  plays 
a  chief  part  in  this  paralysis,  at  all  events 
at  its  commencement,  I  have  only  to  call  your 
attention  to  a  case  reported  by  a  Dr.  Mac 
k^nzie,  in  November,  1859,  of  diphtheria  of  the 
rectum,  which  was  followed  by  pai-aJysis  of  the 
left  lower  extremity  and  severe  neuralgia  ol 
the  same. 

199  Rideau  Street,  Ottawa. 


BI-MONTHLY  NOTES  ON  THERAPEU- 
TICS AND  PHARMACOLOGY. 

BY    R.    L.    MACDONNELL,  B.A.,  M.D,,  M.R.C.S  ,   ENG. 

(Assistant  Demonstrator  of  Anatomy  in  McGill  Univer- 
sity, and  Physician  to  Montreal  Dispensary.) 

The  Fifteenth  Section  of  the  International 
Medical  Congress,  that  of  Materia  Medica  and 
Pharmacology,  does  not  seem  to  have  attracted 
to  its  sittings  as  many  eminent  writers  as  did 
some  of  the  others  ;  nevertheless,  there  were 
some  very  sound  papers  read  there,  and  the 
practitioner  will  be  able  to  glean  some  useful 
information  from  their  perusal. 

The  plan  of  Professor  Eulenburg,  of  Greifs- 


wald,  of  establishing  a  universal  Pharmacopoeia, 
is  one  to  be  commended.  It  has  been  dis- 
cussed at  the  Congresses  of  1875,  1877,  and 
1879,  but  no  progress  whatever  has  been  made 
as  yet.  It  is  proposed  that  the  Latin  language 
should  be  used, — official  translations  being,  of 
course,  permitted.  "Weights,  measures,  etc., 
are  to  be  arranged  according  to  the  French 
Metric  System,  and  temperature  by  the  centi- 
grade thermometer.  The  most  desired  change 
of  all  will  be  the  expulsion  of  the  inert  drugs 
which  form  the  bulk  of  our  codes.  Remedies 
of  general  use,  and  of  the  highest  importance, 
alone  are  to  find  a  place  in  its  pages. 

Why  do  not  our  lecturers  on  Materia  Medica 
insist  upon  their  students  practising  the  Metric 
System  1  This,  however,  is  scarcely  to  be 
hoped  for,  since  most  young  men  go  into  the 
world  entirely  uninstructed  in  the  art  of  pre- 
scribing and  prescription  writing, 

"  Bromide  of  Ethyl  "  was  the  subject  of  Dr. 
"William  Squire's  paper.  After  referring  to  its 
action  as  an  antesthetic  in  surgery,  he  de- 
scribed the  method  of  using  it  in  those  cases 
where  very  slight  anaesthesia  is  required. 
Twenty  or  thirty  drops  will  saturate  a  square 
inch  of  lint ;  this  held  to  the  open  mouth  on 
a  handkerchief,  during  three  or  four  deep  in- 
spirations, will  cause  a  tingling  sensation  down 
the  arms,  with  a  feeling  of  fulness  about  the 
head  and  ears ;  the  breathing  is  freer  and 
deeper ;  the  pulse,  a  little  fuller  and  softer,  is 
not  quickened.  These  slight  eflFects  disappear 
in  a  few  minutes,  when,  should  the  inhalation 
have  only  partially  relieved  the  dyspnoea, 
megrim,  or  neuralgia,  for  which  it  is  used,  it  is 
to  be  repeated, — the  condition  requii-ing  i-elief 
returns  then  less  rapidly,  after  a  longer  or 
shorter  interval,  or  not  at  all.  In  this  way  he 
has  seen  headaches  of  long  duration,  beginning 
with  a  tight  pain  across  the  temples,  and  ending 
in  violent  throbbing,  arrested  and  prevented ; 
intense  side-stitch,  suggestive  of  flardiac  dis- 
ease, recovered  from  altogether;  dyspnoea,  both 
vascular  and  renal,  efiectually  relieved,  and 
spasmodic  cough  controlled, 

Pilocarpin  is  a  remedy  now-a-days  attracting 
a  good  deal  of  attention,  Dr,  Wm.  Squire 
gave  a  second  paper  upon  its  actions  and  uses. 
There  are  two  alkaloids  in  jaborandi — pilocar- 


6 


CANADIAN  JOURNAT. 


pin  and  jabotin — of  different,  even  of  antagon- 
istic proj)ertie8.  Hence  the  infusion  or  tinc- 
ture of  jaboraudi  is  less  certain,  and  perhaps 
less  safe,  than  the  pure  alkaloid.  It  is  possible 
that  pilocarpin  itself  has  not  always  been 
obtained  quite  free  from  admixture  with  its 
associated  but  antagonistic  jaborin.  Muriate 
of  philocarpin,  in  simple  solution,  is  the  best 
form  to  use: — 1  gi"ain  to  15  minims  of  water 
for  hypodermic  use ;  1  grain  to  4  oz.  of  water 
for  internal  use  are  convenient  proportions. 
One-third  grain  is  the  largest,  one- fifteenth 
grain  the  smallest  dose  needed. 

Dr.  Squire's  plan  is  to  give  a  full  dose  at 
once ;  others  give  small  doiies  every  hour  with 
some  warm  drink  or  alcoholic  stimulant,  till 
perspiration  and  salivation  are  freely  estab- 
lished. A  drachm  of  the  tincture,  made  with 
thirty  grains  of  the  leaf,  is  equivalent  to  one- 
third  of  a  grain  of  pilocarpin.  One-fourth  of 
a  grain  of  the  muriate,  injected  hypodermically, 
■will  in  a  few  minutes  produce  suffusion  of  the 
face,  quickened  pulse,  some  throbbing  in  the 
neck,  and  a  general  feeling  of  warmth,  followed 
by  free  perspiration.  This  is  soon  streaming 
profusely  from  all  parts  of  the  surface,  and 
continues  long  after  the  skin  has  become  pale, 
or  even  cool ;  the  pulse  subsides,  whilst  the 
force  of  the  heart's  impulse  is  rather  increased ; 
there  is  a  tendency  to  sleep,  and  generally  a 
fall  of  temperature;  the  perspiration  goes  on 
for  three  or  four  hours ;  there  is  an  increased 
flow  of  saliva,  and  some  increase  of  pharyngeal, 
and  sometimes  of  bronchial  mucus,  that  may 
give  rise  to  trouble  during  sleep  and  require 
attention, — such  a  quantity  of  saliva  may  be 
swallowed  as  to  excite  vomiting.  No  head- 
ache, sickness,  or  depression,  has  been  noticed 
as  a  direct  result  of  this  medicine.  All  the 
secretions  of  the  body,  except  the  intestinal, 
are  increased  by  it ;  the  quantity  of  urine, 
hardly  lessened  during  perspiration,  is  increased 
afterwards^  Dysuria  has  not  been  met  with. 
Swelling  and  tenderness  of  the  sub-maxillary 
salivary  glands  have  remained  for  a  day  or  two 
after  profuse  ptyalism.  The  action  of  the  drug 
is  on  the  peripheral  secreting  apparatus,  and  not 
on  the  nerve  centres,  except  so  far  as  the  first 
action  on  the  vaso-motors  may  dilate  the  vessels, 
and  allow  the  agent  freer  access  to  the  glands. 


Pilocarpin  is  not  anwsthetic.  The  perspira- 
tion induce<l  by  it  does  not  relieve  dysmen- 
orrh(e4,  sciatica,  or  colic.  It  does  not  modify 
•specific  fevers ;  but  given  near  the  time  for 
the  separation  of  the  false  membranes  in 
diphtheria,  it  aids  the  fall  of  temperature  and 
favours  sleep.  -  When  there  is  already  collapse, 
of  course  it  can  do  no  good.  It  is  useful  in  the 
febrile  relapse  of  scarlatinal  nephritis.  The  use 
of  it  has  been  chiefly  in  the  different  kinds  of 
Bright's  disease.  It  may  be  unsuited  to  that 
particular  form  where  dilated  vessels  and 
diminished  blood-pressure  are  associated  with 
a  large  quantity  of  albumen;  yet,  in  these  very 
cases,  it  is  serviceable  to  the  inter-current 
exacerbations  and  conditions  of  accidental  con- 
gestion, not  infrequent  in  their  course,  and  it 
is  preferable  to  the  hot  pack  or  the  vapour 
bath.  In  the  early  stages  of  interstitial 
nephritis,  of  gouty  origin,  it  is  of  great  benefit ; 
in  the  chronic  couise  these  cases  generally 
follow  it  is  olten  useful ;  it  may  be  resoi-ted  to 
in  some  of  the  extreme  effects  of  renal  dropsy, 
and  the  relief  obtained  is  not  accompanied  by 
great  depression.  In  the  chronic  results  of 
parenchymatous  nephritis,  as  after  scarlet 
fever,  it  has  been  found  useful ;  and  that  it 
need  not  be  withheld  in  some  cases  of  scarlet 
fever  itself,  is  proved  by  the  remarkable  results 
obtained  from  it  by  Guttman  in  the  treatment 
of  the  kindred  disease,  diphtheria. 

We  have  now  a  new  ally  in  our  warfare 
against  the  tapeworm.  Pelletierine  is  the  alka- 
loid of  pomegranate  bark.  Dr.  Dujardin 
Beaumetz  read  a  paper  to  the  Congress  upon 
its  action,  as  well  as  that  of  Valvidine  and 
Cedrine.  Pelletierine  was  discovered  by  Tan- 
ret  in  1878.  Its  name  commemorates  the 
services  of  the  French  chemist  Pelletier,  the 
discoverer  of  a  large  number  of  alkaloids,  and 
in  i)articular  of  quinine.  Pelletierine  is  a 
ta^nicide.  The  author  prescribed  the  sulphate 
of  pelletierine  in  combination  with  tannin. 
Thirty  centigrammes  of  the  sulphate,  in  a  solu- 
tion containing  ninety  centigrammes  of  tannin, 
is  given  on  au  empty  stomach.  This  dose  is 
followed  by  one  of  thirty  grammes  of  tincture 
of  jalap.  This  treatment  is  followed  by  the 
compound  expulsion  of  the  tapeworm  with  its 
head,  in  a  majority  of  cases  (nine  out  of  ten). 


OP  MEDICAL  SCIENCE. 


The  above  dose  is  only  huited  for  adults, 
i Recently,  in  Montreal,  I  saw  a  fine  specimen 
of  the  head  of  the  taenia  mediocanellata,  driven 
from  its  home,  evicted,  in  fact,  by  pelletierine 
after  the  failure  of  the  iisual  remedies,  Pelle- 
tierine, in  the  form  of  a  tannate,  is  to  be  had 
in  this  city. 

Strychnia  is  introduced  to  the  profession  in 
a  new  role,  that  of  an  expectorant.  Dr.  Milner 
Fothei-gill  states  that  at  the  Hospital  for  Dis- 
eases of  the  Chest  he  has  found  this  alkaloid 
most  useful  when  the  respiration  was  embar- 
rassed. In  acute  bronchitis  and  emphysema  it 
relieves  the  labouring  respiration,  and  when 
the  right  ventricle  is  dilated,  adds  to  the  effi- 
cacy of  digitalis  most  usefully.  In  lung  con- 
solidation it  is  also  of  service, — indeed,  in  all 
cases  where  the  number  of  respirations  mounts 
over  the  ordinary  proportion  to  the  beats  of 
the  heart  (about  1  to  4),  it  has  seemed  to  be  of 
the  greatest  utility. 

In  Sub-section  lY.,  "  Diseases  of  the  Throat," 
Dr.  Morell  Mackenzie  draws  up  the  following 
conclusions  with  regard  to  the  local  treatment 
of  diphtheria  : — 

1.  Ice  is  useful  in  first  stage,  both  internally 
and  applied  externally  to  the  neck;  contra- 
indicated  when  it  causes  pain,  in  young  chil- 
dren, in  advanced  stages,  and  specially  if  gan- 
grene be  present. 

2.  Steam  inhalations  of  great  service  when 
the  false  membrane  shows  a  disposition  to 
separate,  and  when  it  is  situate  in  the  larynx 
or  trachea. 

3.  Solvents  administered  by  swabbing,  or  in 
the  form  of  spray,  often  highly  beneficial. 
Lime  water  and  lactic  acid  the  best. 

4.  Antiseptics  very  important :  carbolic  acid, 
permanganate  of  potash,  and  chloral  hydrate; 
the  last  being  the  most  certain. 

5.  Antserics,  or  varnishes,  i.e.,  remedies 
which  exclude  the  air  from  the  false  membrane. 
Tolu  dissolved  in  ether  is  the  most  serviceable; 
simultaneous  employment  of  other  local  reme- 
dies (ice,  steam)  not  prt^vented  by  the  use  of 
these  agents. 

6.  Caustics  are  always  injurious,  whilst 
astringents  are  useless  and  sometimes  hurtful. 

Dr.  A.  Tobald,  of  Berlin,  read  a  paper  on 
the  same  subject,  and  came  to  the  same  con- 


clusions. He  further  recommends  cold  pack- 
ing of  body  or  neck,  or  half  baths  when  the 
temperature  is  high. 

How  to  treat  a  case  of  diphtheria  compli- 
cated by  the  presence  of  chronically  enlarged 
tonsils'?  Dr.  Lennox  Browne,  of  London, 
recommends  their  removal,  as  a  local  measure 
having  the  best  result ;  (1)  As  removing  an 
impediment  to  the  respiration  ;  (2)  As  prevent- 
ing the  downward  progress  of  exudation;  and 
(3)  As  an  early  substitute  for,  or  prevention  of, 
the  more  dangerous  measure  of  opening  the 
windpipe. 

In  the  section  of  Obstetric  Medicine  and 
Surgery,  Dr.  Barnes,  in  his  paper  "  On  the 
Treatment  of  Puerperal  Haemorrhage "  still 
recommends  iron  injections.  He  analyzed  the 
dangers  of  uterine  injection,  ferruginous  or 
other,  and  shows  that  the  dangers  peculiar  to 
iron  injections  are  few,  and  for  the  most  part 
avoidable. 

This  paper  is  followed  by  one  on  the  same 
subject  by  Dr.  Thomas  More  Madden,  Obstet- 
ric Physician  to  the  Mater  Misericordiae  Hos- 
pital in  Dublin.  Here  we  have  a  crumb  of 
comfort  for  the  timid  man-midwife,  for  the 
author  states  that  in  a  practice  of  upwards  of 
twenty  years  in  various  countries,  tropical  as 
well  as  European,  and  during  his  connection 
with  the  largest  lying-in  hospital  in  Great 
Britain,  he  has  only  seen  one  case  of  death  from 
haemorrhage  after  child-birth.  To  prevent 
flooding,  the  membranes  should  be  ruptured  as 
early  as  possible  during  labour,  so  as  to  allow 
the  uterus  to  contract  gradually  and  firmly ; 
and  a  dose  of  ergotin,  or  a  drachm  of  the  fluid 
extract  of  ergot,  should  be  injected  hypodermi- 
cally  before  the  head  comes  to  press  upon  the 
perinaeum.  As  a  prophylactic  of  haemorrhage, 
the  efficacy  of  a  course  of  any  astringent  pre- 
paration of  iron  given  during  the  last  months 
of  pregnancy  is  unquestionable. 

The  injection  of  hot  water  he  thinks  uncer- 
tain, and  only  useful  in  cases  of  extreme  de- 
pression of  the  vital  powers  from  excessive 
haemorrhage,  and  after  the  failure  of  other 
remedies.  The  injection  of  a  strong  solution  of 
perchloride  of  iron,  although  generally  as  a 
styptic,  is  so  hazardous,  from  the  risk  of  its 
causing  metro-peritonitis,  that  the  writer  no-w 


8 


CANADIAN  JOURNAL 


seldom  i-esorts  to  it.  But  he  st^ngly  recom- 
mendd  what  he  regards  as  a  most  effective  and 
comparatively  safe  method  of  arresting  post- 
partum haMuorrlia;>e, — namely,  the  introduc- 
tion of  a  sponge,  soaked  in  a  solution  of  the 
perchloride  of  iron,  which  is  to  be  passed  into 
the  uterus  (grasped  in  the  accoucheur's  hanrl), 
and  retained  there  until  a  firm  contraction  i<s 
produced,  by  which  .the  sponge,  and  the  hand 
in  which  it  is  held,  are  expelled  together  from 
the  uterine  cavity,  and  the  flooding  is  stopped. 
External  manual  pressure  is  to  be  made  over 
the  uterus,  in  all  cases,  until  contiaction  takes 
place. 

"Recent  Advances  in  the  Therapeutics  of 
Diseases  of  the  Skin  "  is  the  title  of  the  opening 
lecture  of  the  summer  session  in  the  extra- 
mural school  of  Edinburgh,  and  it  was  given 
by  Dr.  W.  Allan  Jamieson. 

The  writer  highly  approves  of  chrysophanic 
acid  in  psoriasis,  but  tiiiuks  that  Mr.  B.ilmanno 
t*quire's  ointment  (two  drachms  of  tiie  acid  to 
the  ounce)  is  too  strong,  a,nd  recommends  a 
milder  application  (ten  to  fifteen  grains  in  the 
ounce)  of  vaseline.  An  ointment  of  twenty 
grains  will,  I  have  found,  answer  admirably 
for  cases  in  private  and  out-door  practice. 
There  is  not  so  much  erythema  produced  as  is 
commonly  supposed,  and  the  treatment  though 
ultimately  successful,  requires  time.  The 
stronger  preparation  is  useful  in  cases  where 
the  patient  can  be  kept  in  bed,  or  where  a 
rapid  cure  is  called  for.  Dr.  Jamie.son  thiuks 
that  chrysai'obin,  while  equally  efficacious  in 
curing  (for  the  time)  psoriasis,  is  less  apt  to 
induce  the  troublesome  and  alarming  erythema, 
which  so  often  follows  too  energetic  a  use  of 
chrysophanic  acid.  In  psoriasis,  it  should  be 
borne  in  mind  that  a  little  of  the  ointment  well 
worked  into  the  patches,  previously  cleared  of 
their  scales,  does  infinitely  more  good,  and  less 
harm,  than  a  great  deal  dabbed  in.  Practi- 
tioners too  often  prescribe  ointments  without 
taking  care  to  have  all  scabs,  etc.,  cleared  off 
the  diseased  surface,  and  it  is  one  of  the  most 
common  causes  of  failure  in  the.se  cases. 

Pyrogallic  acid  is  not  thought  to  be  well 
adapted  for  extensive  surfaces.  For  psoriasis 
affecting  the  scalp  it  is  perhaps  a  better  applica- 
tion than  chrysophanic  acid,  inasmuch  as  the 


conjuuclivse  are  not  affected  by  it.  It  may  be 
prescribed  in  strength  of  one  drachm  to  the 
ounce  of  lard  or  vaseline.  Besides  its  value  iu 
])Soriasi.s,  pyrogallic  acid  seems  also  to  exert  a 
.slowly  destructive  action  on  some  forms  of  new 
growth,  especially  those  which  are  a  lied  in  a 
somewhat  natural  class  around  the  sarcomata. 
Tliese  it  causes  gradually  to  wither  away,  and 
opens  up  a  more  hopeful  prognosis  in  the  case 
of  tumours  so  apt  to  recur  as  these  are.  Dr. 
Jamieson  thinks  that  it  exerts  an  influence 
something  like  tanning.  Under  its  use  the 
growth  becomes  smaller,  denser,  and  less  apt 
to  bleed,  and  crumbles  away  in  jjarts.  It 
irritates  the  skin  round  the  tumour,  so  that  it 
must  be  guarded  by  covering. 

In  chronic  eczema  of  the  palms,  where  it 
lessens  the  itching,  and  helps  the  fissures  to 
heal,  the  author  has  found  the  common  flexile 
collodion  a  valuable  application, — a  point  worth 
remembering  when  we  have  such  cases  to  heal. 
What  can  be  done  for  tinea  trichophytina 
cruris,  the  so-called  eczema  marginatum'?  Here 
the  parasite  finds  a  favourable  nidus,  aud  suit- 
able conditions  for  its  growth  in  the  warmth 
and  moist  situation  of  the  inner  surface  of  the 
thighs  and  adjoining  parts  of  the  scrotum. 
Freshly  prepared  sulphurous  acid  is  the  remedy. 
It  must  be  quite  fre.sh,  for  it  soon  becomes 
partly  converted  into  sulphuric  acid,  aniri'itant, 
not  a  parasiticide.  It  should  be  sponged  freely 
over  the  part  several  times  a  day.  It  soon 
lessens  the  itching,  and  eventually  cures  the 
disease.  Any  excess  of  iiTitation  caused  by 
the  acid  subsides  when  the  use  is  discontinued 
for  a  day  or  two,  and  some  soothing  ointment 
or  lotion  substituted  for  it. 

The  oleate  of  mercury  is  highly  recom- 
mended as  a  reliable  parasiticide  in  the  most 
obstinate  cases  of  deep-seated  tinea  tonsurans 
of  the  head  in  children.  A  case  is  quoted 
where  five  or  six  applications  cured  a  case  of 
four  months  standing,  and  in  which  the  fungus 
was  proved  by  the  microscope  to  be  deeply 
seated. 

One  can  scarcely  have  too  many  modes  of 
resuscitating  patients  in  chloroform  narcosis. 
A  simple  one  is  that  recommended  by  !?!chiriner 
(Centralblatt  f  Augiinheilkunde)  quoted  by  the 
St.  Louis  Medical  and  Surgical  Journal,  April, 


OF  MEDICAL  SCIENCE. 


9 


1881.  It  is  known  that  in  such  cases  the  fifth 
nerve  is  the  last  to  lose  its  sensibility.  Schirmer 
irritates  the  nasal  mucous  membrane  with  a 
rolled  piece  of  paper  wliich  he  turns  in  the 
nose.  In  dangerotis  cases  he  dips  the  paper  in 
ammonia.  This  plan  seems  an  excellent  one. 
I  took  advantage  of  this  peculiarity  of  the  fifth 
nerve  some  time  ago.  A  hysterical  girl  lay  in 
a  state  of  insensibility;  cold  affusions  had  little 
effect.  An  injection  with  a  con)mon  syringe, 
charged  with  water,  into  the  nostril,  brought 
her  to  instantaneously. 


CLINIC  AT   TORONTO   GENERAL 
HOSPITAL. 

BY  J.  E.  GRAHAM,  M.D. 

Physician  to  the  Hospital  and  Adjunct  Lecturer  on  Medicine,  and 

Lecturer  on  Skia  Dibeases  in  the  Toronto  School  of 

Medicine. 

(Reported  by  G.  W.  Clendenan.) 

Gentlemen, — The  case  which  I  present  to 
your  notice  to-day  exhibits  a  combination  of 
the  symptoms  of  two  diseases,  viz.,  one  of  the 
lymphatic  system  —  Hodgkin's  disease;  the 
other  of  the  nervous  system — locomotor  ataxia 
— the  latter  prest^nting  some  peculiar  features. 
Both  diseases  are  very  rare  as  well  as  very 
obscure  in  their  causation. 

The  following  is  the  history  of  the  case  under 
consideration  : — 

Thos.   McL ,   set.    29,  born  in   Canada. 

Married,  occupation  farmer. 

Family  History. — Good.  Father  and  mother 
both  living,  and  quite  healthy. 

Previous  History. — Has  always  enjoyed 
good  health  up  till  July,  1880,  then,  while 
working  in  the  lumbeijng  districts  of  Michigan, 
was  prostrated  with  a  severe  attack  of  ague 
■which  continued  for  six  weeks.  After  re- 
covery he  felt  very  weak,  and  complained 
of  a  severe  pain  in  the  lower  part  of  his  chest, 
affecting  him  mostly  at  night.  This  continued 
for  three  months  and  then  di&a])peared. 

Last  February  (1881)  he  began  to  complain 
of  a  severe  pain  in  the  lumbar  region,  extend- 
ing upward,  and  also  down  his  legs.  Had  to 
give  up  work  entirely  the  pain  being  of  so 
severe  a  character. 

About  this  time  the  glands  of  the  neck, 
axilla,  and  other  parts  of  the  body  began  to 


enlarge.  He  also  complained  of  night  sweats 
which  continued  till  about  the  1st  of  May,  and 
was  troubled  too  with  nightly  emissions. 

Early  in  June,  while  coming  to  Canada,  he 
caught  a  cold  which  lasted  a  week  and  a  half, 
shortly  afterwards  this  was  followed  by  another 
severe  cold  lasting  three  weeks. 

In  July,  upon  waking  up  one  morning,  he 
noticed  a  numbness  of  his  right  arm ;  before 
night  the  same  feeling  had  extended  to  his  left 
arm  and  to  both  legs.  During  the  course  of 
four  days  it  had  extended  over  all  portions  of 
the  body  except  the  head.  At  this  time  he 
was  seized  with  paralysis  of  the  bladder  and 
bowels,  the  former  of  which  lasted  three  weeks. 
The  paralysis  of  the  bowels,  however,  con- 
tinued for  two  months  before  he  fully  recovered 
their  usp.  For  the  last  three  or  four  weeks  he 
has  been  gradually  losing  ground. 

Present  Condition. — Patient  is  quite  pale 
and  emaciatod,  having  lost  fully  25  pounds. 

The  glands  of  the  neck,  axilla,  and  groin  are 
very  much  enlarged  and  hard  to  the  touch. 
The  si)leen  also  presents  some  enlargement. 
Appetite  poor,  bowels  regular,  pulse  120,  tem- 
perature 99|^°.  Upon  examination  of  the  blood 
by  the  hsemacytometer  Dr.  Sweetnam  found  a 
deficiency  of  the  red  blood  corpuscles  (3,900,- 
000  in  a  cubic  millimetre,  or  about  ^  of  the 
normal  number). 

Sensory  Nervous  Symptoms. — Eyesight  good, 
pupils  slightly  dilated  but  respond  readily  to 
light.  The  opthalmoscope  revealed  no  abnor- 
mality, tactile  sensation  slight,  with  more  or 
less  anaesthesia  of  all  parts  of  the  body  except 
the  head.  He  has  slight  loss  of  muscular 
sense.  He  cannot  readily  distinguish  between 
weights,  nor  can  he  feel  the  prick  of  a  pin, 
although  he  experiences  pain  when  punched  or 
struck.  He  also  complains  of  fulgurating  pains 
extending  down  the  limbs. 

Motor  Nervous  Symptoms. — He  has  want  of 
co-ordination  of  his  muscles,  and  walks  with  a 
peculiar  staggering  gait,  which  is  especially 
marked  upon  closing  his  eyes.  "While  walking 
he  has  a  sensation  of  "  pads  "  undar  his  feet. 
He  also  has  extreme  difficulty  in  picking  up  a 
pin  or  buttoning  up  hh  clothes.  The  patella 
tendon  reflex  is  entirely  absent. 

Trophic  Nervous  Symptoms. — There  is  some 


10 


CANADIAN  JOURNAL 


wasting  of  the  imiscles,  especially  of  the 
hands. 

Diagnosis. — First  of  the  glandular  condition. 
It  is  jwssible  to  have  enlargement  of  the  lym- 
phatics in  various  affections,  viz.,  syphilis, 
scrofula,  sarcoma  or  carcinoma,  leucoc  j'thtemia, 
and  in  Hodgkin's  disease. 

I  think  we  may  exclude  syphilis  without 
further  comment,  as  there  is  no  history  of  it 
whatever.  Had  there  been  any  such  history  it 
would  have  been  very  easy  to  account  for  both 
conditions  present  in  the  case. 

The  diagnostic  points  in  scrofulous  disease  of 
the  glands  are  (1)  It  occurs  usually  in  early 
life  ;  (2)  It  is  acconijjanied  by  other  manifesta- 
tions, as  caries  of  the  bonas  and  low  inflam- 
mations of  the  mucous  membranes,  etc.  ;  (3) 
Theie  is  a  tendency  to  breaking  down  and 
suppuration.  In  this  case  none  of  these 
features  ai'e  exhibited.  It  must  be  admitted, 
however,  that  the  diagnosis  between  scrofula 
and  Hodgkin's  disease  is  often  difficult  and 
sometimes  almost  impos.sible.  Sarcomata  some- 
times affect  the  lymphatic  glands,  but  not  so  gen- 
erally as  we  find  in  this  case.  In  carcinoraata 
the  glands  are  not  usually  affected  unless  the 
infectious  material  is  conveyed  from  some 
existing  tumor  near  at  hand. 

Finally,  we  have  limited  the  diagnosis  to  two 
diseases,  viz.  :  Leucocythsemia  and  Hodgkin's 
disease,  in  both  of  which  enlargement  of  the 
lymphatic  glands  as  well  as  of  the  spleen 
occui-s,  together  with  a  diminution  of  the  red 
blood  corpuscles.  In  leucocythgemia,  however, 
we  have  an  excessive  preponderance  of  the 
white  blood  corpuscles,  whereas  in  Hodgkin's 
disease  the  white  corpuscles  are  either  normal 
or  slightly  increased.  Upon  examination  of 
the  blood  we  have  found  the  latter  condition 
present. 

Therefore,  from  such  examination  as  well 
as  from  the  general  symptoms  present,  I 
am  inclined  to  the  belief  that  the  condition 
of  the  glandular  system  seen  is  that  of 
Hodgkin's  disease.  The  case,  however,  has  not 
been  under  observation  long  enough  to  make 
an  absolutely  certain  diagnosis.  The  clinical 
history  of  the  above  disease  is  characterized 
chiefly  by  two  conditions,  viz.,  an  enlargement 
of  the  lymphatic  glands,  and  a  certt^in  abnormal 


condition  of  the  blood  the  latter  often  giving 
rise  to  the  most  important  symptoms  of  the 
disease. 

1.  As  to  the  enlargement  of  the  glands. 
This  condition  may  be  general,  local,  or  both 
general  and  local.  The  single  glands  are  firm 
and  smooth,  and  as  a  rule  vary  in  size  from  a 
small  nut  to  a  hen's  egg,  but  we  may  have 
aggregated  masses  of  them  often  weighing 
several  pounds.  To  the  touch  they  are  usually 
not  painful,  but  from  pressure  upon  surround- 
ing structures  may  give  rise  to  varied  symptoms: 
thus  the  enlargement  of  the  glands  of  the  neck 
may  obstruct  the  circulation  to  the  brain  by 
pressure  upon  the  carotid  arteries,  thereby 
causingcerebral  anaemia;  again,  the  intrathoracic 
glands  are  sometimes  attected,  and  by  their 
pressure  upon  the  lungs,  give  rise  to  the  most 
disti-essing  symptoms  of  coughing  and  dyspnoea: 
also  by  pressure  upon  the  nerves  they  may  give 
rise  to  neuralgia  and  paralysis.  The  spleen  in 
the  majority  of  cases  is  of  moderate  size,  but 
occasionally  it  reaches  immense  proportions, 
weighing  from  eight  to  nine  pounds.  The  liver 
and  kidneys  also  may  be  enl.'rged.  The  sexual 
organs  too  are  sometimes  the  seat  of  lymphoid 
growth.  The  heart  and  lungs  are  frequently 
affected. 

Regarding  the  condition  of  the  blood,  we  find 
more  or  less  anjemia,  which  is  one  of  the  most 
conspicuous  features  of  the  disease ;  the  cor- 
puscles often  becoming  reduced  to  as  low  as 
sixty  per  cent.  <  f  the  normal  standard.  The 
temperature  is  usually  high,  varying  from  100° 
to  103°. 

Morbid  Anatomy  and  Pathology. — The  glands 
and  various  organs  affected  are  found  to  be 
much  hypertrophied,  and  composed  largely  of 
lymphoid  and  fibrous  matter,  both  being  very 
ranch  increased.  The  lymphoid  growth,  upon 
microscopical  examination,  is  found  to  consist  of 
rounded  cells  existing  in  a  tine  fibrous  stroma, 
and  presenting  a  strong  resemblance  to  the 
round-celled  sarcoma.  If  the  deposition  goes 
on  rapidly  there  is  a  greater  amount  of 
cellular  formation  ;  if,  however,  it  progresses 
more  slowly,  it  partakes  more  of  a  fibrous 
nature.  The  glands  are  soft  or  hard,  according 
to  the  rapidity  of  the  deposit.  In  this  case, 
from  the  hardness  of  tlie  glands,  the  ^mall 


OF  MEDICAL  SCIENCE. 


11 


amount  of  anaemia  and  the  comparatively  low 
temperature  (99f°),  I  would  conclude  that  we 
have  a  comparatively  mild  and  chronic  form 
of  disease  to  deal  with. 

Treatment. — Much  cannot  fee  done  in  the 
way  of  a  cure.  The  treatment  now  adopted  is 
the  same  as  that  for  scrofula  :  tonics,  cod-liver 
oil,  arsenic,  strychnia,  and  phosphorus  are  the 
remedies  mainly  relied  upon.  I  have,  in  a 
previous  case,  tried  chaulmoogra  oil,  but  with- 
out any  marked  benefit.  If  we  knew  more 
regarding  the  causation  we  might  be  able  to 
prevent  the  onset  of  what  appears  to  be  an 
almost  incurable  condition. 

Now,  as  to  the  nervous  disease,  you  will  no 
doubt  notice  the  presence  of  most  of  the 
symptoms  which  I  gave  you  in  a  previous 
lecture  on  locomotor  ataxia.  There  are  shown 
the  numbness,  the  want  of  co-ordination,  light- 
ning pains,  and  the  absence  of  the  patella  tendon 
reflex.  From  the  history  given  it  is  probable 
that  in  July  last  the  patient  suffered  from  a 
subacute  myelitis  attacking  principally  the 
posterior  columns  :  other  portions  of  the  cord 
were  no  doubt  also  affected.  There  was  pro- 
bably also  congcfction  of  the  membranes.  It 
would  appear,  however,  that  after  the  more 
acute  symptoms  passed  off"  the  posterior  columns 
remained  permanently  sclerosed,  thus  account- 
ing for  the  signs  now  exhibited. 

There  may  be  also  some  abnormal  condition 
of  the  anterior  cornua  of  the  gray  matter  giving 
rise  to  the  partial  atrophy  of  muscle.  The 
severe  pain  which  the  patient  experienced  in 
the  lumbar  x-egion  during  February,  may  have 
been  caused  by  meningeal  trouble. 


M.  Vulpian  has  resigned  the  Diaconate  of 
the  Paris  Faculty  of  Medicine,  a  step  deeply 
regretted  on  all  hands.  M.  Beclard  has  been 
nominated  his  successor.  Vulpian  was  the 
twelfth  Dean  of  the  Faculty,  his  predecessors 
being  Augustin  Thouret  (1794—1810),  J.  J. 
Leroux  DesTillets  (1810-23),  Landre  Beauvais 
(1823—30),  Antoine  Dubois  (1830—31),  Orfila 
(1831—48),  BouiUaud  (1848—9),  P.  Berard 
(1849—52),  Paul  Dubois  (1852—62),  Eayer 
1862— 64),  Tardieu  (1864— 66),  Wurtz,  (1866— 
1875),  Vulpiaib(1876— 81). 


PSEUDO-HYPERTROPHIC  MUSCULAR 
PARALYSIS. 

BY  L.  M.  SWEETNAM,  M  D.,  CM. 

The  following  is  a  description  of  a  case  of  the 
above-mentioned  disease,  in  which  during  the 
past  few  weeks  in  the  Out-Patient  Department 
of  the  Toronto  General  Hospital  we  have  been 
using  the  galvanic  current  under  the  direction 
of  Dr.  I.  H.  Cameron,  at  whose  request  we 
report  the  case. 

F.  H.,  aged  eleven  years  and  four  months;  a 
bright  eyed,  active  intelligent  little  fellow,  with 
a  light  complexion,  and  curly  hair,  and  reason- 
ably tall  for  his  age,  was  unusually  pale  and 
delicate-looking  when  born,  this  condition  being 
attributed  by  his  mother  to  excessive  grief  and 
worry  experienced  by  her  during  his  gestation. 
He  began  to  walk  at  the  age  of  16  months,  while 
his  sisters  and  brothers  walked  at  from  twelve 
to  fifteen  months ;  had  scarlet  fever  and  per- 
tussis during  the  first  year  of  his  life  and 
pneumonia  at  eight  years  of  age. 

When  our  patient  was  four  years  of  age,  it 
was  first  observed  that  his  younger  brother, 
aged  two  years,  could  run  much  better  than  he, 
and  was  able  easily  to  overtake  him.  At  this  time 
also  it  was  noticed  that  he  had  great  difficulty 
in  going  upstairs,  and  that  he  always  advanced 
the  left  footand  brought  the  right  up  to  it.  When 
he  fell  he  liad  considerable  difficulty  in  regain- 
ing his  feet.  He  could  and  can  walk  as  far  as 
other  children  of  his  age  without  complaining 
of  being  tired.  The  size  of  his  calves  was  the 
subject  of  remark  and  admiration  from  the 
first,  and  presented  a  marked  contrast  with  his 
thighs.  This  condition  continued  without  much 
aggravation  until  last  winter,  when  he  fell 
heavily  upon  the  ice,  striking  the  back  of  his 
head ;  after  that  he  complained  of  increased 
difficulty  in  getting  upstairs,  and  sometimes 
while  reciting  his  lessons  at  school  his  legs  have 
given  way  and  he  has  fallen  to  the  ground. 
Last  summer  it  was  noticed  that  when  lying 
down  he  was  unable  to  rise  without  assistance. 

Family  history: — Mother  and  father  both 
living  and  well.  Mother  had  seven  children  in. 
eluding  the  patient,  of  these  4  were  girls,  and  3 
boys ;  one  of  the  girls  died  when  1 7  days  old 
of  erysipelas,  and  one  of  the  boys  at  12  years 


12 


CANADIAN  JOURNAL 


of  age  of  heart  disease  consequent  upon  rheu- 
matic fever  following  scarlatina.  Patient  has 
three  sisters  and  a  brother  living,  all  of  whom 
have  had  measles,  scarlet  fever,  and  whooping- 
cough  ;  but  ai"e  at  present  perfectly  healthy 
and  well  developrd.  His  mother  had  six 
brothers,  of  whom  two  are  living  and  four  dead. 
One  dying  of  measles  at  seven  years  of  age, 
another  of  iufantile  diarrhoea  at  seven  weeks' 
another  of  atrophy,  or  marasmus  at  fifteen 
months,  and  the  last  of  typhoid  fever  at  twenty- 
three  years  of  age.  Mother  had  one  sister  who 
is  living,  and  well,  unmarried.  Father's  family, 
as  far  as  known,  were  all  well  developed  and 
healthy.  Information  regarding  his  grand- 
parents we  failed  to  procure. 

Present  condition: — Judging  from  the  appear- 
ance of  patient's  face,  no  one  would  suppose  for 
a  moment  that  he  was  in  any  way  ailing,  and 
he  often  says  :  "  If  my  legs  were  only  strong 
I  would  be  as  well  as  anybody.  He  is  4ft.  4in. 
in  height,  face  plump  and  ruddy.  His  upper 
arms  are  atrophied  and  soft,  forearms  ap- 
parently normal  ;  the  muscles  of  the  trunk  are 
much  atrophied ;  chest  flat  and  scapulae 
winged ;  his  thighs  are  a  little  under  the  nor- 
mal size,  and  his  calves  much  increased  in  size 
and  projecting;  his  spine  is  considerably  curved, 
antero  posteriorly,  with  the  concavity  back- 
wards, and  a  line  falling  vertically  from  the 
neck  would  just  touch  tho  prominence  of  the 
sacrum ;  this  lordosis  disappears  while  he  is 
sitting.  The  pelvis  is  tilted  slightly  forwards, 
and  the  weight  of  the  abdomen  falls  unduly  in 
the  same  direction. 

The  following  are  some  circumferential 
measurements  recently  taken  :  Left  calf,  12  in.  j 
right  calf,  11 1  in.  ;  left  thigh  (middle),  12^  ; 
right  thigh  (middle),  12  in.  ;  left  arm  (middle), 
7^  ;  right  arm,  7^  ;  left  forearm  (largest  part), 
6^  in.  ;  right  forearm,  6f  in.  Circumference 
of  chest  at  level  of  nipples  with  arms  by  the 
side,  24|  in. ;  with  arms  raised  above  the  head, 
26  in.  His  gait  and  carriage  are  very  peculiar, 
and  could  not  fail  to  arrest  the  attention  even 
of  the  most  unobserving.  The  head  is  carried 
slightly  forwards  with  the  chin  protruding ; 
the  shoulders  raised  and  thrown  back  and  the 
abdomen  forwards  ;  the  knees  remain  some- 
what bent,  walks  more  than  naturally  upon  the 


forepart  of  the  foot,  with  a  tendency  to  stub 
the  toes  against  any  unevenness  in  the  side- 
walk. In  walking  there  is  an  inclination  to 
st^parate  the  feet  and  to  turn  out  the  tofs,  and 
this  is,  perhaps,  more  marked  while  standing  ; 
in  walking  also  he  waddles  consideraoly,  ap- 
parently to  keep  the  body  over  the  foot  which 
is  upon  the  ground  ;  the  arms  also  are  swung 
more  than  usual.  When  lying  down  ho  is  un- 
able to  rise  without  firet  rolling  over  on  one 
sid«  and  then  raises  himself  by  using  his  arms  ; 
he  usually,  however,  rolls  over  on  his  face, 
raises  himself  on  ail  fours,  gradually  straightens 
his  knees  with  bis  hands  still  on  the  floor, 
throws  out  the  rump  like  a  dog  stretching  him- 
self, and  lastly,  places  one  hand  and  then  the 
other  ou  his  knees  and  straightens  his  back  by 
gradually  changing  the  position  of  his  hands  on 
his  thighs,  raising  one  and  then  the  other  until 
he  is  perfectly  erect,  in  other  words,  climbs  up 
his  own  legs. 

Excepting  a  slightly  diminished  tendon 
reflex,  there  is  no  evidence  of  diminished  or 
perverted  nerve  power  or  energy,  other  than 
muscular  weakness.  His  intellect  is  clear  and 
unimpaired,  and  there  is  a  perfect  absence  of 
pains,  aches,  or  numbness.  He  still  places  his 
hands  upon  his  knees  in  ascending  the  stairs, 
although  he  says  that  he  both  goes  upstairs 
and  walks  with  much  more  comfort  and  ease 
to  himself  than  foru)erly  (that  is  before  the 
electricity  was  applied).  The  improvement, 
however,  is  less  apparent  to  others. 

Some  of  his  muscles  are  much  diminished  in 
bulk,  notably  those  of  the  trunk  and  upper  arm, 
while  those  of  the  calf  are  much  increased. 
The  electro-motility  of  the  first-named  muscles 
to  both  the  galvanic  and  faradic  current  is 
slightly  lowered,  but  more  so  than  that  of  the 
muscles  of  the  calf.  While  the  muscles  of  the 
calf,  however,  respond  readily  to  the  current, 
the  integument  over  this  region  appears  much 
less  sensitive  than  that  over  the  rest  of  the 
body.  The  treatment  thus  far  has  consisted  in 
the  application  of  the  constant,  or  galvanic  cur- 
rent to  the  spine,  and  directly  and  indirectly 
to  the  muscles  of  the  limbs  and  trunk,  and  in 
the  administration  of  cod  liver  oil,  iodide  of 
iron,  and  ai  senic ;  the  result  has,  as  already 
stated,  been  satisfactory,  and  we  hope  from 
time  to  time  to  report  progress  in  this  case 
which  to  us  is  one  of  considerable  interest. 


OF  MEDICAL  SCIENCE. 


13 


MALIGNANT  DISEASE  (ROUND  -  CEL- 
LED SARCOMA)  OF  ISCHIUM. 

BY  H.   T.  MACHELL,  M  B.,  L.R.C.P.E 
Surgeon  to  the  Toronto  Dispensary  and  Children's  Hospital. 

G.  D ,  set.  53,  farmer,  had  enjoyed  good 

health,   except    for   attacks    of    asthma    (and 
irritability  of  the  bladder  with  purulent  urine 
on  one  occasion)  up  till   March  or  April  last, 
when,  on  jumping  out  of  a  buggy,  he  struck 
his    left    hip  against  a  spike   projecting   from 
a  gate  post,  experiencing  a  great  deal  of  sicken- 
ing pain  at  the  moment,  but  limping  thereafter 
for  a  few  days  only.     Between  six  and   eight 
weeks  subsequently  he  began   to  complain  of 
pain   in  the  neighbourhood  of  the   hip;    but 
members  of   his  family  noticed   no   lameness 
beyond  a  slight  halt  habitual  to  him   from  an 
old  Pott's   fracture.     Pain,  increased  at  night, 
was  observable  in  June,  and  about  this  time  he 
began    to   use  a   cane  in    walking.     The    pain 
extended  down  to  the  foot  (both  in  front  and 
behind) ;  and  he  was  supposed  to   be  suffering 
from  sciatica.     He  shortly  took   to  crutches 
and  sleep  was  soon  almost  entirely  denied  him 
in  consequence   of  the  pnin.     He  came  under 
my  observation  on  the  10th  of  October  last,  at 
night,  and  half  a  grain  of  morphia  hypodermi- 
cally  secured  him  more  rest  that  night  than  he 
had  had  for  a  month   or  six  weeks  previously. 
On  the   llth  a  careful   examination  was  made 
by  Dr.  McCausland,  of  Yorkville,  Dr.  Cameron, 
and  myself.     There  was  found  neither  shorten- 
ing nor  lengthening  of  the  limb,  but  there  was 
muscular  fixity,  and   any  lateral  movement  or 
concussion  of    the  sole  of   the  left  foot  gave 
rise  to  intense  pain  and  tremour  of  the  muscles. 
The  passive  hip-joint  motions  were  fully  pre- 
served.    The  circumference  of  the  left  leg  was 
somewhat  less  than  that  of  the  right.     Turning 
him  over  on  his  face,  a  good  deal  of  shrinking 
of  the  left  leg  and  buttock  was  observable,  and 
the  gluteal  fold  of  that   side  was  less  marked, 
and  lower.     No  special  pain  on  pressure,  in  the 
course  of  the  sciatic,  but  a  good  deal  every- 
where between  the   tuber  ischii  and  the  hip- 
joint.     The  tuher  ischii  itself  was  tender  and 
slightly  thickened.     On  examination,  per  rec- 
tum, a  sligh  fulness  and  thickness,  with  a  small 
amount    of    pain   on    pressure,    was   detected 


nearly  opposite  the  acetabulum.  No  glandular 
enlargement  in  either  groin  ;  body  fairly  well 
preserved  ;  colour  good  ;  cheeks  red  and  florid, 
owing  to  capillary  ectasia. 

A  diagnosis  of  malignant  disease  of  the 
ischium  was  made.  As  there  were  twitchiugs 
of  the  muscles,  and  pain  on  motion,  I  went  to 
patient's  home  iu  the  country,  and  put  on 
extension  by  weight  and  pulley.  This  afforded 
some  relief,  and  was  worn  for  about  two  weeks, 
when  patient  grew  tired  of  it,  and,  finding  that 
the  muscular  twitching  had  ceased,  it  was  then 
abandoned.  The  amount  of  morphia  taken 
per  or  em,  had  to  be  gradually  increased  from  a 
quarter  grain  twice  to  half  a  grain  thrice  a  day. 
The  general  medication  consisted  of  iron  and 
quinine. 

I  visited  patient  again  on  the  17th  of  Nov. 
There  was  then  a  good  deal  of  swelling  or 
puffiness,  over  adductors  of  thigh  ;  the  tender- 
ness on  pressure  was  increased,  as  was  also  the 
swelling  of  the  tuber  ischii.  Morphia  had  now 
to  be  increased  to  three-quarters  of  a  grain  four 
or  five  times  a  day.  Rectal  exploration  showed 
increase  of  internal  bulging  with  communication 
of  impulse  from  finger  in  rectum  to  hand  on 
gluteal  region,  and  broadening  of  the  tvher. 
Tnere  was  quite  a  noticeable  swelling  in  the 
groin,  partly  above  Poupart's  ligament.  In 
accordance  with  the  suggestion  of  another 
medical  man  who  was  called  in,  and  who 
suspected  osteoperiostitis,  poultices  were  ap- 
plied, iodide  of  potash  given  internally,  and  a 
long  splint  put  on.  The  splint,  however,  was 
only  tolerated  twenty- four  hours.  I  saw  him 
again  on  the  24th  of  November,  with  two 
other  surgeons.  The  swelling  per  rectum  was 
markedly  increased,  obscuring  all  bony  pro- 
minences except  tuber.  There  was  oedema  of 
the  whole  leg  and  the  left  buttock,  was  now 
much  larger  than  the  right.  The  urine,  di'awn 
off  by  cathetei",  was  fetid,  grumous,  and  floccu- 
lent,  but  was  not  tested.  The  bladder  was 
then  washed  out  twice  daily.  A  week  before 
his  death  he  became  delirious,  and  continued 
so  ;  but,  three  days  before  the  end,  the  pain 
ceased  and  the  morphia  was  abandoned.  Death 
relieved  him  of  his  sufferings  on  the  llth  of 
December,  just  two  months  after  coming  under 
observation. 


14 


CANADIAN  JOURNAL 


Poat-mortem  examination,  of  the  abdomen 
only,  made  by  Dr.  Hillary,  of  Aurora,  and  my- 
self, showed  liver  uuaffecteil ;  both  kidneys 
pyelitio,  slightly  enlarged,  and  two  little 
abscesses  in  the  cortex  of  the  left.  The  psoas 
muscle  was  not  affected,  nor  was  the  rectum. 
The  ala  of  ilium  was  sound  ;  but  the  lower 
portion,  and  the  ischium,  including  the  tuber, 
and  the  two  rami  of  the  pubes  were  entirely 
disorganized  and  supplanted  by  a  soft,  some- 
what elastic  neoplasia,  the  only  portions  of  bone 
remaining  being  two  loose  plates  in  the  part  cor- 
responding to  the  horizontal  ramus  pubis,  and 
a  cup-shaped  shell  of  the  inner  portion  of  the 
tvher  ischii.  The  cartilaginous  face  alone 
remained  of  the  acetabulum,  and  through  this 
several  buds  of  new  growth  projected,  whilst 
one  or  two  presented  on  the  head  of  the  femur 
about  the  ligamentum  teres.  No  glandular 
enlargement  was  found. 


A  CASE  OF  EXTENSIVE  CANCER  OF 
STOMACH  WITHOUT  EXTERNAL 
TUMOUR  AND  WITHOUT  PAIN,  PRE- 
SENTING AN  INTERESTING  EC- 
TOPIA OF  THE  RIGHT  KIDNEY. 

BY  H.   H.  WRIGHT,  M.D. 

W.  A.,  £et.  79,  gardener,  presenting  no 
history  of  nosological  heredity,  had  enjoyed 
good  health  all  his  life  with  the  following 
exceptions  : — During  the  last  five  or  six  years 
he  had  suffered,  every  fall,  from  a  mild  attack 
of  dysentery,  presenting  nothing  unusual  in  its 
symptomatology  and  yielding  readily  to  treat- 
ment. For  the  last  year  or  two  an  icteioid 
tinge  of  skin  had  been  observable.  In  February 
or  March  last  he  had  an  attack  of  thrombosis 
of  the  veins  of  the  left  leg  which  pursued  a 
a  rather  rapid  course  to  resolution.  Dyspeptic 
symptoms  existed  for  a  little  more  than 
a  year,  and  consisted  in  flatulence  and 
sour  stomach  not  easily  controlled.  In 
July  last  the  appetite  failed  and  the  dyspepsia 
became  more  pronounced,  gradually  increasing 
to  such  an  extent  that  he  declined  to  take  food 
on  account  of  the  flatulence  and  eructations  to 
which  it  gave  rise.  During  August,  September, 
and  October  hectic  fever,  sweats,  and  rapidity 
of  pvdse  were  noticed.     At  no  time  was  there 


complaint  of  epigastric,  rachidian,  or  other 
pain  ;  and  no  intumescence  nor  dullness  was 
discoverable.  Vomiting  only  began  ten  days 
before  death  and  was  unaccompanied  by  pain. 
In  a  day  or  two  after  it  set  in  he  threw  up 
some  blood  and  also  passed  some  by  the  bowel. 
For  the  last  eleven  days  of  his  life  he  abstained 
from  the  ingestion  of  food,  and  was  fed  entirely 
by  nutrient  enemata,  and  the  envelopment  of 
the  body  in  cloths  soaked  in  milk.  There  was 
no  albuminuria.  He  died  in  December  greatly 
reduced  in  flesh  but  still  preserving  some 
subcutaneous  fat.  On  inspection  after  death 
the  abdominal  wall  f)resented  half  an  inch  in 
depth  of  fat,  the  great  omentum  still  pretty 
well  laden  was  tucked  in  and  drawn  over  some- 
what to  the  left  side  leaving  intestines  on  right 
uncovered ;  as  far  as  could  be  seen,  how. 
ever,  it  was  healthy ;  on  raising  it  up  the 
intestines,  large  and  small,  were  seen  to  be 
shrunken  on  themselves  and  more  or  less 
empty.  No  trace  of  stomach,  and  very  little 
of  liver,  was  visible,  these  viscera  having 
retreated  up  under  the  sternum  and  ribs.  On 
pulling  on  the  great  omentum,  however,  they 
were  drawn  down  aiid  it  was  seen  that  the 
stomach  was  involved  in  a  large  cancerous 
mass  to  which  the  omentum,  pancreas,  spleen 
and  left  border  of  the  liver,  were  adherent. 
The  liver  was  very  small  and  firm  b^it  con- 
tained no  secondary  deposits.  The  spleen 
was  rather  large  and  in  its  anterior  two- 
thirds  was  as  white  as  lai'd.  The  whiteness, 
however,  was  entirely  in  the  capsule  which  was 
one-eighth  of  an  inch  in  thickness,  the  pulp 
was  fairly  normal  and  showed  no  deposits.  The 
pancreas  was  largely  involved  in  the  neoplasia. 
The  pyloric  orifice  of  the  stomach  was  free,  as 
was  also  the  cardiac,  but  the  new  growth  which 
involved  its  anterior  and  posterior  walls  alike 
extended  to.within  half  an  inch  of  the  former 
and  within  one  inch  and  a  half  of  the  latter. 
Each  wall  presented  a  somewhat  oval,  rather 
solid  or  elastic,  fatty-looking  new  gro.wth  of 
the  size  of  a  hen's  egg  and  slightly  juicy,  that 
in  the  posterior  wall  being  two  inches  in  thick- 
ness and  that  in  the  anterior  one  inch  and  a 
half.  These  masses  were  surrounded,  to  the 
extent  indicated  above,  by  hypertrophied, 
thickened,  infiltrated,  villous  processes  of  mucous 


OF  MEDICAL  SCIENCE. 


16 


membrane  which  here  and  there  had  undergone 
digestion  or  sphacelation.      The   new  growth 
was  continuous  across  the  lesser  curvature,  but 
along  the  greater  there  was  a  channel  beneath  the 
projecting  masses  in  each  wall    (which  met  but 
did  not  coalesce)  sufficienb  to  lodge   the  index 
finger.      The  whole  three  walls  of  the  stomach 
were  involved  in  the  disease.     The  glands  along 
the  lesser  curvature  were,  of  course,  implicated 
in  the  disease  but  the  retro-peritoneal  glands 
did  not  appear  to  be  infected.     The  left  kidney 
was   enlarged  and    presented    on    the   surface 
three  or  four  large  cysts,  each  capable  of  con- 
taining from  one  to  two  ounces  of  fluid.     The 
right  kidney  was  not  in  its  usual  situation,  but 
was  found  snugly  ensconced  in  a  good  bed  of 
fat  and  connective  tissue,  lying  transversely  in 
the  pelvis,  close  to  the  sacrum  and  beneath  the 
promontory.     It  was  of  good  size  and  supplied 
by  two  large  arteries  given  oflF  from  the  middle 
of  the  fork  of  the  aorta  at  its  bifurcation  into 
the   iliacs ;    the   larger   branch    going    to    the 
hilus  and  the  smaller  to  the  head  of  the  kidney. 
The  surface  of  the  gland  presented  a  number  of 
pin-head  cysts.      The  middle  and  right  lobes 
of   the    prostate    were    considerably    enlarged. 
The   lungs   presented  the  condition   of  small- 
lunged  emphysema,  an  1  did  not  fully  occupy 
the  thoracic  cavity,  thus  allowing   the  stomach 
and  liver  to  retreat  upwards.    Their  colour  was 
ashy  white,  deeply  mottled  with  pigment.     The 
left  presented  old  pleuritic  adhesions.  The  bron- 
chial   glands    were    enlarged    and    pigmented. 
The  heart  was  well  overlaid  with  fat  but  fairly 
normal  with  rather  thin  walls. 


M.  Paul  Bert,  the  distinguished  physiologist, 
who  lately  introduced  the  method  of  anaesthesia 
by  nitrous  oxide  gas  under  a  pressure  of  several 
atmospheres  in  major  surgical  operations,  has 
entered  the  French  Ministry  as  Minister  of 
Public  Instruction,  in  succession  to  M.  Jules 
Ferry. 

«  m^^* 

At  the  Academy  of  Medicine,  M.  N.  Gue- 
naun  de  Mussy  presented  two  memoirs  from 
Madame  Ernest  Hart,  a  distinguished  graduate 
of  the  Paris  School,  and  wife  of  our  eminent 
confrere.  Dr.  Hart,  editor  of  the  British  Medi- 
cal Journal. — L'  Union  Medicale, 


LEPROSY  IN  CAPE  BRETON. 

BY  A.  MACPHEDRAN,  M.D.,  TORONTO. 

Surgeon  to  the  Toronto  Dispensary. 

In  addition  to  the  cases  reported  in  Septem- 
ber number  of  the  Journal,  T  received  the  notes 
of  the  following  cases  from  the  late  Mr.  Wm. 
Fletcher,  B.  A.,  some  time  ago,  but  owing  to  his 
anticipated  return,  about  the  time  of  his  death, 
they  were  withheld  in  the  hope  that  he  might 
obtain  more  material  before  leaving  the  Island. 
Since  the  publication  of  the  previous  notes,  Mr. 
Fletcher  ascertained  that  Betsy  McCarthy 
never  came  in  contact  with  any  cases  of  leprosy 
or  heard  of  it  prior  to  her  own  illness.  Her 
family  history  was  good.  Her  children  were 
all  born  before  her  illness  began,  and  the  disease 
was  well  developed  in  her  before  it  showed 
itself  in  her  children  or  the  others  mentioned. 
These  subsequent  cases  occur  among  the 
Highland  Scotch  residing  in  the  east  side  Lake 
Ainslie  region,  which  is  situated  some  distance 
from  that  of  Lake  O'Law ;  these  people  knew 
nothing  of  the  Lake  O'Law  cases  till  after  the 
disease  appeared  among  themselves.  Lake 
Ainslie  is  twelve  miles  long  by  two  to  four 
broad,  surrounded  by  high  hills,  the  whole 
forming  a  most  picturesque  scene.  Its  waters 
are  clear  and  limpid,  supplied  by  many  small 
brooks  from  the  surrounding  hills,  and  drained 
by  a  small  river,  the  Margaree. 

Case  I. — John  McLean,  farmer,  is  reported 
having  died  of  leprosy.  He  and  Richard 
McCarthy,  of  former  history,  supposed  their 
cases  identical :  all  McCarthy's  symptoms  were 
well  developed  in  this  case. 

IL,  III.,  IV. — Three  McKinnons  :  Archie, 
Donald,  and  Sarah,  farmers,  died  of  a  disease 
exhibiting  the  characteristic  symptoms  of 
leprosy.  No  signs  of  the  disease  in  any  of 
their  relatives. 

V. — Donald  Gillis,  farmer,  brother  of  John 
Gillis,  of  South- West  Egypt,  Margaree,  Inver- 
ness County,  C.B.,  died  of  same  disease. 

VI. — Archie  McLean,  farmer,  unmarried, 
brother  of  the  three  following  cases,  died  in 
1868,  aged  37,  after  an  illness  of  20  years. 
There  were  the  usual  symptoms  as  given  in  the 
next  case. 

VII. — Neil  McLean,  aged  39,  farmer,  has  4 


16 


CANADIAN  JOURNAL 


disease  that  began  with  pain  and  swelling  in 
the  knee,  which  ulcerated.  Tumors,  followed 
by  ulcers,  appearing  on  the  hands  and  feet, 
causing  the  lo8s  of  parts  of  the  fingers  and  toes. 
The  bones  only  jiartially  project,  and  the  ulcers 
in  some  are  still  discharging.  No  tumor's  in 
other  parts  of  body.  No  hoarseness.  Sensa- 
tion good,  except  in  hands  and  feet.  Has  only 
occasional  lancinating  pains  in  limbs.  Skin  is 
tense,  thick,  and  brownish  on  hands  and  feet, 
but  not  scaly.  He  is  despondent.  General 
health  and  appetite  are  good,  and  he  walks 
about.  His  brother  Archie,  mentioned  above, 
had  swellings  in  all  parts  of  body.  The  parents 
were  healthy  :  the  father  died  at  the  age  of  50, 
and  mother  at  73.     Family  history  good. 

VIII. — Margaret  McLean,  sister  of  Neil, 
unmarried,  aged  35  years.  Disease  began  at 
age  of  16.  Her  history  is  the  same  as  that  of 
Neil,  and  she  is  now  in  about  the  same  con- 
dition. 

IX. — Christina  McLean,  another  sister,  un- 
married, aged  40,  contracted  the  disease  at  the 
age  of  17.  Is  now  in  a  condition  similar  to 
the  other  two.  John,  an  elder  brother,  is  quite 
well,  as  are  his  wife  and  all  his  children.  One 
other  case,  also  Scotch,  is  reported  near  the 
outlet  of  Lake  Ainslie,  with  symptoms  similar 
to  those  of  Neil  McLean.  Mr.  Fletcher  in- 
tended seeing  this  case  when  leaving  the  Island. 
Cases  were  reported  in  other  parts,  but  all 
proved  on  investigation  to  be  only  Norwegian 
Scabies. 

There  is  no  connection  traceable  between  the 
four  groups  in  the  above  nine  cases  ;  there  is 
no  relationship,  and  there  was  not  much,  if 
any,  acquaintanceship.  There  is  no  specific 
history  in  any  of  them,  and  in  no  case  was  the 
disease  transmitted  to  the  children,  as  in  the 
Lake  O'Law  ca.ses.  In  these  the  cause  in  each 
must  be  primary,  unle.ss  due  to  contagion  in 
some  of  them. 

In  this  and  the  former  paper  must  be  in- 
cluded all  the  cases  of  leprosy  in  Cape  Breton  ; 
had  there  been  other's  they  could  not  well  have 
passed  unnoticed  by  Mr.  Fletcher,  as  he  has 
b«'en  over  the  whole  Island  very  minutely  in 
connection  with  the  survey.  It  affords  me  a 
melancholy  pleasure  putting  on  record  this 
account  of  leprosy  in  Cape  Breton  from  the 
materials  collected  by  the  late  Mr.  Fletcher. 
Had  he  lived  this  is  but  an  earnest  of  what  he 
would  have  done  for  the  advancement  of  me*lical 
science  of  which  he  was  such  a  devoted  and 
enthusiastic  student. 


SEVERE    FALLS   WITHOUT    LOSS    OF 
CONSCIOUSNESS. 

BY  R.   BARRINGTON  NEVITT,  B.A.,  M.B., 

Surgeon  to  the  Hotue  of  Providence,  Toronto  Ditpentary,  and 
Hospital  for  Sick  Children. 

I.  A.  B.,  set.  45,  a  stout,  fleshy,  labouring 
man,  an  alcoholic,  fell  from  the  summit  of  the 
roof  of  the  new  chapel  of  the  House  of 
Providence.  He  slid  along  the  steep  incline 
of  the  roof  and  fell  sheer  to  the  ground  a  total 
distance  of  60  feet.  He  was  picked  up  and 
conveyed  into  the  building.  He  was  perfectly 
conscious,  but  sufTered  severely  from  the  shock. 
There  was  a  CoUes'  fracture  upon  each  arm. 
He  complained  of  pain  only  in  the  left  leg  and 
in  the  back.  The  left  ilium  was  found 
to  be  fractured,  the  ci'est  from  the  anterior 
superior  spinous  process  to  near  the  posterior 
superior  spinous  process  being  freely  movable. 
The  leg  was  flexed,  adducted  and  inverted. 
He  vomited  frequently,  in  the  intervals 
calling  for  whiskey.  Five  hours  after  the 
accident,  about  half  an  ounce  of  blood-stained 
urine  was  withdrawn  by  catheter.  (He  had 
evacuated  the  contents  of  the  bladder  imme- 
diately before  ascending  to  his  work).  At  8 
p.m.,  six  hours  after  the  fall  he  died. 

II.  B.  C,  set.  28,  a  stout  active  man, 
painter  by  occupation,  stepped  from  the  dormer 
window  of  a  building  in  course  of  erection, 
upon  a  scaffolding  which  gave  way  precipitating 
him  a  distance  of  35  or  40  feet  to  the  ground, 
where  he  was  pinned  down  by  the  superincum- 
bent debris  of  the  .scaffolding.  He  lent  his  aid 
in  throwing  off  some  of  the  timbers,  and  being 
extricated  walked  ahout  50  yards  and  was  put 
into  a  waggon  and  c;irried  home.  The  injuries 
received  were  of  the  most  trivial  character  :  a 
slight  bruise  over  the  right  scapula  and  a 
bruise  on  the  right  knee  and  ankle,  and 
a  strain  or  brui-e  in  the  right  lumbar  region, 
which  was  considerably  swollen  and  tendt^r  to 
the  touch,  though  not  at  all  discoloured.  The 
treatment  was  purely  expectant,  he  was  kept 
quiet  for  a  few  days,  and  then  returned  to 
work,  suffering  from  a  slight  stiff'nesa  in  the 
lumbar  region  when  he  reached  down  or  at- 
tempted to  lift  a  heavy  weight.  He  complained 
of  a  girdling  pain  an  inch  or  two  above  the 
umbilicus;  four  weeks  after  the  accident  this 
returned  slightly  and  there  was  a  slight  show 
of  blood  in  a  motion  from  bowel,  since  then  he 
has  had  no  recurrence  of  the  pain.  He  is  now 
at  work  and  feels  well. 


OF  MEDICAL  SCIENCE. 


17 


Mtctm$ :  ^lUrtirtttc. 


EXTRACT  FROM  THE  HARYEIAN  LEC- 
TURES ON  THE  PROGNOSIS  AND 
TREATMENT  OF  CHRONIC  DISEASES 
OF  THE  CHEST  IN  RELATION  TO 
MODERN  PATHOLOGY. 

BY  JAMES  E.  POLLOCK,  M.D.,  F.R.C.P., 

Senior  Physician  to  the  HospiUl  for  Coniumption  and  Diseases 
of  the  Chest,  Brompton. 

******* 

As  I  am  speaking  of  pure  air,  this  is,  per- 
haps, a  fitting  place  to  dwell  for  a  moment  on 
what  is  called  change  of  air,  and  the  influence 
of  climate.  I  must  here  deal  only  with  the 
general  views  arising  out  of  our  pathological 
knowledge. 

First,  while  degenerative  processes  which  we 
have  been  considering  are  going  on  in  the 
lung,  patients  should  not  be  allowed  to 
travel  at  all.  Do  not  send  the  feverish  abroad; 
for  what  is  fever  1  The  loading  of  the  blood 
with  the  detritus  of  degenerative  processes.  Do 
we  find  that  patients  gain  in  weight,  improve 
in  strength,  or  progress  at  all  while  fever  is 
going  on]  Certainly  not.  Our  examination  into 
the  real  meaning  of  high  temperature  is  that  it 
means,  or  is  correlative  with,  waste — progres- 
sive local  disease — nature's  efibrts  at  clearing  out 
and  clearing  ofi"  morbid  material  not  completed. 
Why  should  such  persons  be  sent  to  change  ot 
air]  Will  any  climate  stop  such  processes  as  are 
jx)uring  septic  matter  into  their  blood  1  We  say 
no ;  and  add,  such  had  better  be  in  their  own 
homes,  with  home  comforts,  surrounded  by 
the  accustomed  faces,  and  the  well-considered 
provision  for  small  wants.  Locomotion  would 
in  itself  be  an  evil — fancy  the  cabin  of  the 
steamer  ;  the  journey  prolonged  through  the 
night  to  reach  the  favoured  climate ;  the  con- 
tracted cubic  space  of  the  railway  cai'riage — to 
a  man  whose  temperature  is  102°,  and  who  is 
undergoing  the  malaise  inseparable  from 
fever. 

When  local  morbid  processes  have  ceased  (as 
we  know,  from  want  of  further  material  on 
which  to  act),  the  system,  well-nigh  exhausted, 
may  still  be  capaV>le  of  revival.  The  moment 
wasting  ceases  and  nutrition  revives,  that  is  the 


time  for  removal,  for  getting  into  sunshine,  for 
breathing  purer,  dry,  bracing  air ;  and  then 
only  should  a  patient  be  removed.  For  there 
is  no  climate,  just  as  there  is  no  specific,  which 
can  cure  this  "  consumption  "  of  many  forms; 
but  there  are  influences  which  can  second  re- 
viving nature,  stimulate  enfeebled  digestive 
powers,  and  arouse  vital  energy.  Among  these 
is  the  influence  of  change — any  change — of 
locality ;  but,  above  all,  to  countries  where 
winter  is  short,  and  the  sun  shines  on  most 
days,  so  that  the  sick  man  can  be  out  for  a  part 
at  least  of  every  day. 

Fashion,  guided  by  medical  knowledge,  has 
wisely  of  late  set  itself  against  sending  much 
enfeebled  patients  to  warm,  damp,  relaxing, 
climates  ;  and  Maderia  has  been  abandoned  for 
the  Engadine.  The  usual  results  and  mistakes 
have  occurred ;  some  have  benefitted,  and  some 
have  (from  want  of  selection  on  which  1  have 
dwelt)  perished  miserably  on  the  mountain-side, 
who  should  never  have  left  England.  But,  on 
the  whole,  we  must  say,  as  the  result  of  our 
inquiry  how  far  modern  pathology  has  assisted 
us  in  treatment,  that  all  which  tends  to  lung- 
expansion  and  improvea  respiratry  movements, 
all  which  promotes  a  healthy  circulation  in 
the  parts  of  the  lung  surrounding  defined 
cavities,  all  which  tends  to  improve  the  tone, 
and  therefore  to  lessen  the  secretion  from  the 
bronchial  membrane,  which  forms  so  large  a 
part  of  phthisis,  is  to  be  preferred  for  our 
patient ;  and,  therefore,  bracing,  pure,  upland 
air  is  preferable  to  low,  damp,  ill-drained  locali- 
ties ;  and,  as  heat  and  moisture  promote  secre- 
tion and  relax  mucous  membranes,  hot  and 
damp  climates  are  not  so  suitable. 

Again,  the  digestive  processes  are  best 
strengthened  in  dry  and  rather  cold  air,  and  on 
them  depends  our  patient's  possibility  of  regain- 
ing flesh  and  repairing  waste.  It  is  well  known 
that  sea-air  U  very  favourable  in  promoting  all 
these  requirments. 

I  make  a  summary  of  these  views,  on  which 
I  have  acted  for  many  years. 

Persons  ought  not  to  travel  at  all  with 
feverish  symptoms ;  with  secondary  complica- 
tions, as  diarrhoea;  with  a  large  amount  of 
local  disease  in  any  stage  ;  with  both  lungs  dis- 
eased ;  with  poor  digestion  and  gi-eatly  lowered 


18 


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nutrition  ;  or  in  such  a  state  of  weakness  or 
emaciation  as  to  require  home  comforts,  pecu- 
liar beds  or  chair,  or  varieties  of  invalid 
cookery. 

A  case  in  the  first  stage,  already  chronic* 
does  for  travelling  about,  with  frequent  change 
of  residence.  Tlie  complicatioa  with  bron- 
chitis or  asthma  is  generally  much  bene- 
fitted. 

Chronic  single  cavity,  with  retraction  of 
walls  accomplished  or  proceeding,  is  favourable 
for  removal  to  a  dry,  bracing  locality,  if  the 
hsemoptysical  element  be  wanting  in  the  case. 

That  form  of  diffused  disease  in  the  lung 
which  I  have  described — without  much  dullness 
or  signs  of  massing  of  disease,  with  pi-etty  large 
chest,  and  with  moderate  emaciation — generally 
does  well  on  a  sea-voyage. 

I  need  not  occupy  much  of  your  time,  if  you 
have  followed  our  investigations,  with  the 
meaning  of  the  several  varieties  of  phthisis,  by 
an  enquiry  whether  any  specific  remedy  for  the 
disease  is  likely  to  be  found. 

A  specific  is  an  agent  which  meets  some 
definite  form  of  disease,  and  opposes  its  pro- 
gress, or  even  effects  its  (Jestruction.  But  have 
we  in  phthisis  any  such  defined  disorder?  Ex- 
amine it  as  we  have  done  here,  and  it  is  resolv- 
able into  many  forms,  really  differing  in  patholo- 
gifcal  results  and  in  symptoms,  in  progress,  and 
in  termination.  Its  history  is  made  up  of 
many  progressive  changes,  and  variety  in 
mode  is  its  very  character.  Such  variety  eludes 
the  action  of  any  remedy  ;  and  remedies  of 
efficacy  cannot  be  presumed  to  address  them- 
selves to  multiform  phenomena,  and  certainly 
cannot  meet  in  succession  and  overcome  those 
morbid  changes  which  are  the  result  of  mixed 
chemical  and  vital  actions,  progressively  in- 
creasing and  [changing  their  mode  of  destruc- 
tiveness  as  the  disease  advances.  We  have  been 
tracing  the  destructiveness  of  phthisis  to  a  kind 
of  degeneration  which  the  morbid  products 
undergo  in  the  lung ;  to  the  nature  of  the 
lung-impaction,  its  form,  limit,  and  distribu- 
tion ;  and  to  the  amount  of  suffering  which  the 
system  undergoes  from  fever,  waste,  and  second 
ary  infections.  To  these  influences  are  found 
added  such  agencies  as  hereditary  features,  age, 
sex,  temperament,  and  the  complications  with 


other  disorders.  All  these  were  described  as 
essential  considerations  in  e.stiniating  the  gra- 
vity of  any  case  of  phthisis.  But  is  not  this 
summary  of  chronic  morbid  products  in  the 
lung — some  tending  to  death  and  degeneration, 
others  to  more  raj)id  disintegration,  and  others 
again  to  contractile  results  in  the  tissues — a 
picture,  not  of  one,  but  of  many  disorderSjWhich, 
while  we  have  stamped  them  with  a  common 
name,  have  diverging  tendencies  and  endless 
pathological  v  »riety  1 

To  meet  all  this,  we  are  to  seek  for  a  single 
remedy,  if  we  are  to  search  for  a  specific  which 
shall  so  directly  address  itself  to  the  morbid 
state  that  every  progressive  step  which  we  know 
to  constitute  the  history  of  phthisis  shall  cease. 
Again,  if  there  be  (as  some  suppose)  a  consti- 
tutional cause,  inherited  or  acquired,  which 
leads  up  to  and  decides  the  character  of  the 
local  affection,  this  cause,  involving  deep- 
seated  errors  in  the  most  vital  processes  of 
sanguification  and  nerve-power,  can  scai'cely 
be  supposed  to  be  within  the  reach  of  a  single 
agent. 

My  purpose  here  is  to  give  expression  to 
general  views  of  treatment,  gathered  from  our 
more  recent  pathological  knowledge;  and  I  con- 
clude that  we  are  in  these  days  going  farther 
away  from  "  constitutions  "  and  "  specifics," 
and  drawing  nearer  to  the  treatment  which 
shall  address  itself  to  diseased  local  conditions. 
The  tendency  of  the  day  to  seize  that  which  is 
tangible,  and  susceptible  of  proof  by  physical 
laws  is  swaying  the  practice  of  medicine  and 
surgery,  as  it  is  swaying  our  views  of  the  whole 
universe  and  of  man  himself.  In  this  way  we 
may,  indeed,  find  much  error  and  many  falla- 
cies; but,  if  it  in  the  least  assist  us  to  practical 
views  of  treatment,  we  are  bound  to  accept 
the  teaching  of  this  s  ^hool,  provided  that  it  re- 
main true  to  its  ovvn  profession  of  only  holding 
that  which  is  susceptible  of  physical  proof.  Ex- 
periment first,  and  aftewards  theory. 

I  must  recommend,  therefore,  a  thoughtful 
attention  in  practice  to  the  local  relief  of  the 
lung.  Let  us  treat  congestions,  when  they  occur 
by  local  depletion  ;  let  us  not  be  in  a  hurry  ta 
stop  a  moderate  haemoptysis  by  styptics,  while- 
the  flow  of  blood  is  relieving  an  overloaded! 
lung.     See  what  relief  a  bloodletting  gives   to* 


OF  MEDICAL  SCIENCE. 


19 


au  engorged  right  side  of  the  heart  with 
secondary  congestion  of  lung,  with  hcemoptysis. 
We  do  not  give  gallic  acid  and  ergot  here,  be- 
cause the  overflow  is  Nature's  mode  of  relieving 
the  engorged  organ.  No  more  should  we  treat 
moderate  congestive  hsBmoptysis  by  astringents. 
Let  us  treat  cavities  in  the  lung  on  the  same 
views  that  the  surgeon  treats  abscesses  with 
insufficient  exit  for  matter.  Let  us  drain  them, 
and  then  dry  them  up,  and  during  this  process 
support  our  patient  by  rest  and  nutrients. 

In  speaking  of  rest  in  chronic  chest-disease, 
we  should  remem  ber  the  constant  movements 
of  the  lung  and  of  the  chest.  It  is  this  feature 
which  makes  an  essential  difierence  between 
the  lung  and  any  other  part  of  the  body  except- 
ing the  heart.  It  is  always  moving.  It  is  its 
incessant  movement  which  makes  the  sursfical 
treatment  difficult.  The  surgeon  can  rest  a  dis- 
eased joint;  but  he  cannot  rest  a  diseased  lung. 
While,  however,  it  is  impossible  to  stop  all 
movements  of  the  chest,  it  is  quite  possible  to 
control  them  ;  and,  in  certain  conditions  of  dis- 
ease, the  strapping  the  lower  ribs,  so  as  to 
limit  their  motion  in  breathing,  is  a  great  relief 
to  the  patient,  and  gives  time  for  reparative 
processes.  Thus,  in  pneumothorax,  it  is  a  great 
relief  to  the  suffering  of  the  patient.  In  pleuritic 
pain,  so  common  in  the  lateral  and  inferior  parts 
of  the  chest,  it  will  often  at  once  enable  the 
patient  to  breathe,  and  especially  to  cough, 
without  distress.  During  certain  periods  also 
of  disintegrative  process  and  of  cavity-forma- 
tion, strapping  the  side  is  useful ;  and  again  in 
chronic  contracting  fibroid  alterations,  where 
to  fix  the  side  is  to  imitate  natui-e.  It  is 
also  useful  after  operations  of  tapping  either 
the  lung  or  the  pleura. 

If  you  ask  me  whether,  after  some  experience 
of  the  treatment  of  chronic  lung-disease,  I  am 
of  opinion  that  some  forms  are  curable  and 
cured  ;  whether  some  varieties  have  had  in- 
creased prolongation  conferred  on  them  by  treat- 
ment ;  and,  on  the  whole,  whether  the  great 
load  of  consumption  has  been  somewhat  light- 
ened of  its  pressure  on  the  community  in  my 
time, — I  answer  frankly  "  Yes "  to  all  these 
questions.  Rapid  forms  of  disease  are  still  rapid 
and  uncontrollable ;  acute  tuberculosis  is  not 
amenable  to  any  treatment  ;  and  so  of  the  con. 


gestive  form  which  I  have  described.  But  the 
chronic  varieties  of  phthisis  are  much  more 
prolonged  in  our  day,  because  they  are  no 
longer  shut  up  in  hot  rooms  and  denied  fresh 
air  and  exercise ;  neither  do  they  live  so 
much  surrounded  by  their  own  emanations;  and 
the  whole  habits  of  society  have  improved  their 
condition  along  with  that  of  all  others.  The 
requirements  of  health  are  more  considered ; 
and,  with  a  lessened  mortality  per  thousand, 
man  lives  longer.  The  use  of  oil  and  nutrient 
medicines  has  added  many  years — T  know  not 
how  many — to  the  phthisical  life  ;  but  so  have 
exposure  to  air,  increased  facilities  for  travel, 
increased  personal  cleanliness.  We  are  not 
degenerating  in  this  generation.  And  let  it  be 
said,  once  for  all,  that  phthisis  is  not  an  English 
disease  ;  and  that,  with  all  its  disagreeableness, 
I  am  satisfied  that  the  subjects  of  phthisis 
unable,  for  want  of  mo  ins,  to  escape  from  it, 
live  as  long  here  as  in  any  country. 

Yet,  withal  I  know,  as  we  all  know, 
how  much  remains  to  be  done ;  how  much 
patient  investigation — yes,  even  now — when 
we  seem  to  have  exhausted  all  microscopical 
and  pathological  inquiries,  when  we  appear  to 
know  the  whole  story  of  the  disease,  and  have 
accumulated  a  great  literature  about  phthisis 
alone. 

Again,  if  you  ask  me  whether  I  think  that 
this  later  German  pathology,  which  seems  so 
clear  and  has  somewhat  displaced  the  French 
pathology,  will  itself  be  replaced  by-and-bye  by 
somy  nearer  approach  to  truth,  I  say  sui*ely 
"  Yes."  But  in  the  meantime  let  us  live  by  the 
best  light  we  have  ;  and,  above  all,  if  there  be 
any  practical  truth,  anything  which  can  save  a 
life  or  lessen  a  symptom  of  disease,  let  us  seize 
hold  of  that  and  appropriate  it,  whether  it  con- 
tradict our  own  theory  or  not.  It  is  by  this 
light  that  I  regard  the  views  which  dwell  most 
on  local  disease  and  local  remedies.  This  idea 
of  localisation  may  be  be  the  key,  as  I  believe, 
to  much  valuable  treatment.  *  *  *. — British 
Medical  Journal. 


Sir  James  Paget  is  suffering  from  one  of 
the  attacks  of  pneumonia  to  which  he  has 
been  so  subject  since  his  blood-poisoning.  He 
has  gone  to  Nice  for  the  winter. 


20 


CANADIAN  JOURNAL 


RENZI  ON  IODIDE  AND  BROMIDE  OF 
POTASSIUM  IN  HEART  DISEASE  * 

An  interesting  review  of  an  article  on  this 
siiltjf'Ct  in  the  Italian  Medical  Gazette  of  Janu- 
ary, ]881,  appeai-s  in  the  Lyon  Medical  oi  10th 
July,   1881.     The  writer  of  the   article  (Pro- 
fessor Kenzi)  has  evidently  studied  with  care 
the  actions  of  thrte  important  drugs   largely 
used  now-a-days  in  cases  of  heart-disease — viz., 
bromide   of    potassium,    iodide   of    potassium, 
and  chloral  hydrate;   and  he  has  given  some 
important   information  legarding  them.     Bro- 
mide of  potassium  is    shown  to    have  such    a 
direct  influence  on  the  heart  and  capillaries,  as 
to   entitle   it   to    a   high    position    among  the 
cardio-vahcular  drugs.     According  to  Dr.  Du- 
jaidin-Beaunietz,  who  considers  it  one  of  the 
best    heart-tonics    we    possess,    the    bromide, 
besides  being  a  nervine  sedative,  acts  diiectly 
on    the    heart,   and   lessens   considerably   any 
irregular  action  of  that  organ.     He  says  that, 
as  a   nervine  sedative,  the  drug   is    useful  in 
counteracting  the  sleeplessness  which  so  greatly 
enfeebles  and  wears  out  patients  suffering  from 
heart-disease,    while   its    value   in   such   cases 
is   greatly    enhanced    by   its   direct   beneficial 
action  on  the  diseased  organ  itself.      According 
to   Professor    See    (largely  quoted,  along  with 
Diijardin-Beaumetz,    by    the     writer    of    the 
article),    bromide   of    potassium    is    especially 
useful  in  heart-affections  where  we  have  dimin- 
ished  arterial    pressure,    rapid    and    irregular 
action  of  the  heart,  passive  congestions,  cedema, 
cyanosis,  dyspnoea,  and  sleeplessness. 

Iodide  of  potassium  is  shown  to  be  very 
beneficial  in  dyspnoea  arising  from  heart  disease. 
It  is  also  of  great  value  in  arresting  degenera- 
tive chauges  in  the  heart-tissue.  The  action 
of  chloral-hydrate  on  the  heart,  as  observed  by 
Profe>sor  Renzi,  is  at  once  to  diminish  the 
rapidity  oi  its  action,  and  after  a  time  to 
reduce  its  energy.  The  drug  seems  to  act 
on  the  heart,  by  paralyzing  either  the  cardiac 
ganglia  or  the  vaso-motor  centres  in  the  brain. 
Tin;  researches  of  Claude  Bernard,  Rokitan.sky, 
and  others,  would  indicate  that  the  latter  are 
chiefly  affected  by  the  administration  of  chloral, 
for  they  found  that  it  caused  great  diminution 

•  Translated  in  6Iasgo\r  Medical  Journal. 


of  blood-pressure  by  dilatation  of  the  capillaries- 
In  summing  up  his  observations  on  the  three 
drugs  referred  to.  Professor  Renzi  says  of 
bromide  of  ])Otas8ium  that  it  lensens  the 
anxiety  of  patients  suffering  from  heart-disease, 
gives  them  a  certain  sense  of  comfort,  and 
enables  them  to  breathe  freely.  Under  its 
influence  sleep  is  more  easily  obtained,  is  more 
tranquil,  and  of  longer  duration  than  when 
induced  by  other  drugs.  It  is,  moreover,  a 
more  natural  sleep.  The  brouiide  reduces 
undue  rapidity  of  the  heart's  action  and  of 
respiration.  Cough,  however,  seems  to  be 
aggravated  by  the  use  of  bromide  of  potassium 
alone. 

Of  iodide  of  potassium,  he  says  that  it  is  a 
most  useful  drug  in  diseases  of  the  heart. 
One  of  its  chief  effects  is  a  complete  relief 
from  dyspnoea  and  all  asthmatic  symptoms. 
Chloral-hydrate  is  not  much  esteemed  by  him. 
It  can  procure  sleep  of  a  kind,  but  is  of  no 
use  in  relieving  the  dyspnoea  so  troublesome  in 
cases  of  heart  disease.  It  is,  moreover,  danger- 
ous when  given  in  conjunction  with  iodide  of 
potassium,  the  latter  drug  apparently  having 
the  effect  of  greatly  increasing  its  soporific 
action. 

From  Professor  Renzi's  summing  up,  it 
would  seem  that  a  combination  of  the  iodide 
and  bromide  of  potassium  is  a  most  beneficial 
remedy  in  cases  of  heart-disease. — London 
Medical  Record. 


Macdonald  on  Carbolic  Acid  in  Whoop- 
iNG-CouGH. — Dr.  Macdonald  {Edinburgh  Med. 
Jour.,  1881,  p.  1094)  says  that  on  extended 
trial  he  finds  carbolic  acid,  in  doses  of  one- 
fourth  of  a  minim  to  a  child  of  six  months, 
one-half  minim  for  a  year,  and  one  minim 
for  two  years  and  upwards,  to  be  the  best 
remedy  for  whooping-cough.  The  whooj)  goes ; 
the  vomiting  ceases ;  the  paroxysms  are  modi- 
fied in  intensity  and  frequency.  This  result 
Dr.  Macdonald  believes  to  arise  from  an  action 
similar  to  that  of  creasote  on  the  motor  fibres 
of  the  vagus  to  the  stomach,  and  from  a  lower- 
ing of  vitality  of  the  sjiecific  germ  of  whoo|)ing 
cough  disease.  This  points  to  the  antiseptic 
treatment  of  the  zymotic  diseases  generally. — 
London  Medical  Record. 


OF  MEDICAL  SCIENCE. 


21 


INTRA  CRANIAL  TUMOURS. 

Dr.  Bernhardt  has  collected  57  cases  of 
tumour  of  the  cerebral  superficies,  and  it  is 
noteworthy  that  in  as  many  as  45  cases  the 
tumour  was  in  the  fronto-parietal  region  ;  twice 
only  was  it  in  the  occipital  region,  and  in 
no  instance  in  the  temporo-sphenoidal  region. 
Motor  symptoms  were  present  in  all  but  ten 
cases.  The  author  points  out  a  peculiarity 
in  the  mode  of  onset  of  the  hemiplegia  in 
these  cases.  The  whole  side  is  not  paralysed 
at  once,  but  first,  perhaps,  the  arm,  then  the 
face,  and  then  the  leg.  The  hemiplegia  is 
made  up  as  it  were  of  a  succession  of  attacks 
of  raonoplegi,  and  is  generally  preceded  or 
followed  by  localized  epileptiform  convulsions. 
The  occurrence  of  a  hemiplegia  with  these 
characters  gives  us  good  ground  fur  supposing 
that  the  tumour  is  in  the  motor  area  of  the 
cerebruii,  or  immediately  adjoining  it.  Bern- 
hai'dt  has  met  with  only  three  cases  in  which 
there  was  tumour  of  the  motor  area  without 
motor  symptoms.  There  seems  to  be  no  diag- 
nostic sign  by  which  we  can  distinguish  between 
superficial  tumours  of  the  motor  region,  and 
tumours  of  the  cerebral  medulla  implicating 
the  same  region ;  and,  even  if  tumour  of  the 
motor  region  be  diagnosed,  we  are  unable  to 
say  how  far  it  spreads  anteriorly  or  posteriorly 
into  non-motor  areas,  for  tumours  of  these 
parts  are  often  latent  as  regards  symptoms. 

In  cases  of  tumour  of  the  cerebral  lobes, 
ataxy  and  disturbance  of  the  muscular  sense 
point  to  the  parietal  lobe  as  the  seat  of  the 
tumour.  Hemianopsia  and  subjective  optical 
phenomena  appear  sooner  perhaps  in  tumour  of 
the  occipital  lobe  than  elsewhere.  Disturb- 
ances of  vision  unaccompanied  by  paralysis 
of  the  ocular  muscles  are  very  suggestive  of 
tumour  of  the  cerebral  lobes;  still  the  presence 
of  solitary  symptoms  of  paralysis,  ptosis  for 
exanple,  does  not  absolutely  forbid  this  diag- 
nosis. Another  impn-taut  symptom  in  these 
cases  is  mental  derangement,  which  shows 
itself  generally  as  loss  of  intelligence  and 
obtuseness.     Speech  is  also  fiequently  afiected. 

The  most  trustworthy  indication  of  tumour 
of  the  corpus  striatum  or  optic  thalamus  is  the 
appearance  of  involuntary  muscular  move- 
ments (half  like  tremors,  half  like  the  move- 


ments of  chorea)  in  limbs  that  become  paretic, 
or  are  already  so,  and  which  often  present 
symptoms  of  diminished  sensibility.  The  move- 
ments are  very  commonly  confined  to  one  side. 
In  tumours  of  the  corpora  quadrigemina  and 
pineal  gland,  there  is  no  symptom  of  pathogno- 
monic value ;  but  if  there  be  paralysis  of  the 
trochlear  nerve  and  bilateral  paresis  of  cor- 
responding branches  of  the  oculo-motor  nerves, 
with  unimpaired  sensibility  and  absence  of 
unilateral  paralytic  or  convulsive  attacks,  there 
is  every  likelihood  that  the  tumour  is  situated 
in  this  part  of  the  brain.  The  symptoms  that 
are  most  to  be  relied  on  in  the  diagnosis  of 
tumour  of  the  cerebellum  are  occipital  head- 
ache, a  reeling  gait,  and  a  [)ecu]iar  vertigo. 
The  vertigo  is  independent  of  paralysis  of  the 
ocular  muscles,  and  may  be  felt  even  when  the 
patient  is  at  rest.  Sudden  death  is  frequently 
observed  in  these  cases,  and  is  probably  due 
to  pressure  on  the  adjoining  respiratory  centre. 
— London  Medical  Record. 


PROF.  H.   C.  WOOD   ON  THE   THERA- 
PEUTIC ACTION  OF  DIGITALIS 
ON  THE  HEART. 

Two  points  in  conclusion — (1)  in  regard  to 
the  cumulative  action,  and  (2)  in  regard  to  the 
cause  of  the  slow  action  of  digitalis.  The 
remedy  acts  slowly  in  producing  its  full  effect, 
and  its  effects  are  very  permanent  when  they 
do  appear.  Digitalis  acts  slowly  and  cumula- 
tively, not  only  because  of  its  special  influence 
upon  the  heart,  but  because  it  only  comes  very 
slowly  into  contact  with  the  heart-structure, 
since  it  osmoses  slowly  into  and  out  from  the 
body.  The  practical  point  is  this:  watch  the 
kidneys  when  giving  large  doses  of  digitalis ; 
if  water  be  not  passed  freely,  then  cumulative 

action  will  be  apt    to  occur The  longer 

the  digitalis  is  in  acting,  the  more  likely 
ir  is  to  have  a  lasting  effect.  After-  abdominal 
tapping,  the  digitalis  often  shows  itself  in 
reducing  the  heart's  action.  Either  it  has 
been  lying  in  the  intestines  unabsorbed,  or  in 
the  cellular  tissue ;  probably  all  the  fluids  are 
saturated  with  the  drug.  Digitalis  is  a  very 
useful  remedy  in  cases  of  syncope  and  collapse. 


22 


CANADIAN  JOURNAL 


Formerly,  alcohol  nlone  was  used.  One  of  the 
advances  of  modern  therapeutics  has  been  to 
teach  the  danger  of  giving  large  doses  of 
alcohol  in  cases  of  surgical  shock.  Belladonna 
and  digitalis  are  proper  remedies  given  by 
hypodermic  injection.  The  pnlse  begins  to  fill 
up  in  twenty  minutes  or  half  an  hour.  No 
irritation  is  produced  at  the  point  of  puncture. 
Throw  in  twenty  minims  at  once,  and  expect 
to  find  the  result  in  half  an  hour.  He  did 
not  wish  his  remarks  to  be  understQpd  as 
declaring  that  digitalis  was  entirely  without 
danger,  but  he  had  used  it  in  hundreds  of 
cases,  and  had  seen  men  apparently  d^ing 
revive  under  its  effects.  It  is  important  to 
stop  it  as  soon  as  evidence  appears  in  the 
pulse  that  it  is  beginning  to  be  absorbed. 
Used  in  this  way,  he  did  not  believe  that 
there  would  ever  be  any  serious  cases  of 
poisoning  with  it.  —London  Medical  Record. 


Diabetic  Coma. — Dr.  Dreschfeld  read  a  paper 
on  diabetic  coma,  taking  as  a  basis  an  analysis 
of  about  fifty   published   cases,   together  with 
some  unpublished  ones  which  had  occurred  in 
his  own   practice  and  that  of   his  colleagues. 
Diabetic  coma  occurred  in  young  persons.     Ii 
might  come  on  a  few   months  after  the   first 
appearance  of  diabetic  symptoms,  or  within  the 
first  or  second    year,   rarely  later   than    that. 
According  to  the  most  prominent  symptoms, 
three  forms  might   be  distinguished  ;  one  form, 
which  resembled,  and  possibly  was,  an  acute 
alcoholic  intoxication ;  a  second  form,  chiefly 
characterized  by  drowsiness,  soon  passing  into 
coma ;  and  a  third  form,  by  far  the  most  com- 
mon, and  in  which   the  coma  was  preceded  by 
dyspnoea,  sickness,  epigastric  pain,   and  often 
delirium,  and,  in  some  rare  cases,  by  convul- 
sions.   Important  aids  in  foretelling  the  possible 
advent  of  the  coma  in  diabetes  were  the  peculiar 
odour  of  the  breath,  and  the  presence  in  the 
urine  of  aceto-acetic  ether,  by  giving  a  peculiar 
claret-red  colour  on  the  addition  of  perchloride 
of     iron.       Amongst    the    chief   post-mortem 
changes  found,  were  the  presence  in  the  blood 
of  large  amounts  of  fat,  and  traces  of  aceto-acelic 
ether,  and  of  the  two  bodies  into  which  it  split 
up  (aceton  and  alcohol).     The   kidneys,  which 
might  appear  normal  to  the  naked  eye,  often 


showed  changes  when  microscopically  examined ; 
the   most   noteworthy  change  was  a   peculiar 
necrotic  condition  of  the  epithelium  of  the  con- 
voluted tubes,  seen  in  three  cases  examined  by 
Dr.   Di'eschfehl,  and  in  two  cases  recently  re- 
ported by  Ebstein.     The  pathology  of  diabetic 
coma  was  considered  at  length,  and  none  of  the 
existing  theories  was  found  to  account  for  all 
the  cases.       Against    the    acetonaemia    theory 
might  be  urged  the  following.    1.   Experimental 
researches  on  animals  showed  that  only  very 
large  doses  both  of  aceton  and  of  aceto-acetic 
ether  produced    toxic   symptoms.     2.  In  man 
also,    both   these  bodies    i)roduced    no   effects, 
even  if  given  in  large  doses  (five  grammes). 
3.    In    some    cases    of   diabetic     coma,    these 
bodies  were  absent  both  from  the  urine    and 
the  blood.     4.  Aceto-acetic  ether  occurs  in  the 
urine   in   other   cases    than  diabetes,   without 
producing  the  combination  of  symptoms  seen 
in    diabetic    coma.       Against   the    view    pro- 
nounced   by   the  late   Dr.    Sanders   and    Dr. 
Hamilton,  according  to  which  fat-eraboli   were 
the  cause  of  the  symptoms,  the  following  objec- 
tions might  be  urged.     1.  Experimental  facts 
showed  that,  unless  large  quantities  of  fat  were 
injected,  the  fat  was  again  eliminated,  without 
producing  any  effect.     Something  similar  seem- 
ed to  obtain  for  man  according  to  Bergmann's 
observations.     2.  Fat-embolism  was  often  found 
after  death,  though,  during  life,  no  symptoms 
pointing  to  it  existed   (Moulin).      3.  In  four 
cases  of  diabetic  coma,  Dr.  Dreschfeld  carefully 
examined,  post  mortem,,  the  lungs,  liver,  and 
kidneys,  and  found  no  fat-emboli,  though,   in 
two  out  of  these  four  cases,   Dr.  Gamgee  de- 
tected  a  large    amount  of    fat   in    the    blood. 
Diabetic  coma  might  be  looked  upon   as  some- 
what analogous  to  uraemia,  and  as  consisting  of 
some  acute  intoxication,  caused  by  the  piesence 
in    the   blood    of    a    toxic    agent   (possibly  an 
oxydation-jjroduct  of  sugar),  the  elimination  of 
whicli  was  interfered  with    by  one   or  other  of 
the  organs   (chiefly  the  kidney)   having    their 
functions  im{)aired.     As  it  was  highly  probable 
that  these  oxydat  ion-products  were  due  to  the 
action  of  a  probable  ferment  on  the  sugar,  a 
rational  treatment  for  such  cases  would  be,  the 
administration  of  large  doses  of  an  antiseptic  or 
antiferment.      So   far,  however,  such  treatment 
had  had  no  more  success  than  any  other  treat- 
ment (injection  of  solution  of  salt,  transfu.sion 
of  blood,  inhalation  of  ozone,  etc.),  which  had 
been  attempted. — British  Medical  Journal. 


OF  MEDICAL  SCIENCE. 


2S 


Cerebral  Symptoms  in  Dyspepsia. — M. 
Leven  has  reported  in  Le  Progres  Medical, 
May  28,  1881,  one  hundred  cases  which  tend 
to  show  the  existence  of  cerebral  phenomena 
whose  presence  has  been  heretofore  overlooked 
in  dyspepsia.  Thus  he  has  seen  patients  sud- 
denly struck  down  in  the  street  with  true 
apoplectic  attacks  which  last  from  ten  minutes 
to  a  quarter  of  an  hour.  Such  cases  were 
believed  to  be  epileptic,  but  M.  Leven  suggests 
that  they  were  in  reality  simply  dyspeptic, 
since  the  cerebral  symptoms  entirely  disap- 
peared when  the  digestive  troubles  had  been 
cured.  In  dyspepsia  the  intelligence  is 
unaffected,  and  there  is  never  any  mental 
disorder.  Certain  cerebral  faculties  may  be 
altered,  but  the  ego  remains  intact.  This  affec- 
tion of  the  higher  faculties,  this  weakening  of 
the  will,  of  action,  of  memory,  and  of  the  power 
of  speech,  may  be  readily  observed.  In  some 
cases  the  patients  are  unable  to  determine  upon 
an  act,  and  they  have  to  make  a  decided  effort 
to  perform  what  is  generally  an  almost  instinc- 
tive movement,  as  lor  instance  to  pick  up  any- 
thing that  they  have  just  dropped.  In  such 
cases  the  memory  is  impaired  and  speech  is 
difficult,  more  especially  after  meals.  The 
patients  are  melancholy,  and  suffer  from 
cutaneous  hypersesthesia,  a  point  which  dis- 
tinguishes them  from  the  hysterical. — Medical 
News  and  Abstract. 

«iw»^. 


Phthiriasis  is  not  a  very  uncommon  disease 
as  characterized  by  the  presence  of  the 
ordiaary  louse  (Pediculus  communis)  but 
the  case  which  has  been  well  reported  by  Dr. 
M.  Goldsmith,  Rutland,  Vermont,  {Medical 
Record,  October  29,  1881,)  is  so  relatively  rare 
as  to  merit  mention.  A  woman  came  into  his 
office  who  complained  of  an  intense  itching 
caused,  according  to  her  statement,  by  insects 
crawling  over  her.  On  causing  a  profuse 
diaphoresis  a  number  of  brownish  insects 
emerged  from  the  sweat  pores.  These  on 
investigation,  were  found  to  be  pigeon  or  hen 
lice  (Dermanyssus  Avium.)  The  use  of 
diaphoresis,  sulphur,  tar  water,  mild  solutions 
of  corrosive  sublimate  and  the  precautions  usual 
in  phthiriasis  resulted  in  a  cure.  Similar  cases 
have  been  reported  by  Ait,  Simon  and  Bor>  de 
St.  Vincent. — Chicago  Medical  Review. 


Meklard  on  the  Action  of  Hydrate  of 
Chloral  in  the  Excretion  of  Sugar  by  the 
Urine. — F.  Meklard  agrees  with  the  opinion 
of  Mering  and  Musculus,  that  in  animals 
under  the  influence  of  chloral  the  urine  nevei- 
contains  sugar  {Archiv  fur  Exper.  Path.,  Paris 
Med.)  He  injected  under  the  skin  of  a  dog 
a  certain  quantity  of  hydrate  of  chloral,  and 
then  made  a  puncture  in  the  fourth  ventricle. 
The  urine  examined  never  contained  sugar. 
In  another  animal  he  first  made  the  puncture  ; 
there  was  then  glycosuria  ;  he  then  injected 
chloral,  and  the  sug.^r  disappeared.  If  the 
vagus  were  divided  at  the  level  of  the  neck, 
and  the  central  end  were  excited,  reflex 
glycosuria  was  produced  ;  but  this  latter  phe- 
nomenon did  not  show  itself  in  chloralised 
dogs.  In  the  same  way,  the  urine  did  not 
contain  sugar  in  a  dog  which  had  breathed 
carbonic  oxide,  but  which  had  first  absorbed 
five  grammes  of  chloral.  This  manifest  action 
of  chloral  on  the  excretion  of  sugar  has  been 
similarly  applied  to  the  human  subject.  In 
a  diabetic  patient  who  was  placed  under  its 
influence,  a  diminution  in  the  quantity  of  the 
urine,  and  of  the  sugar  contained  in  it,  was 
noted.  In  a  second  patieut,  it  was  simply 
observed  that  the  quantity  of  urine  had  greatly 
diminished. — London  Medical  Record. 


Artificial  Hunyadi  Janos  Water. — The 
natural  Hunyadi  Janos  water  was  observed  to 
be  an  efficient,  safe,  and  agreeable  purgative  in 
many  chronic  cases.  It  is,  l.owever,  found  to 
be  too  expensive  for  hospital  use,  and  it  was 
resolved  to  try  it  artificially.  At  first  it  was 
made  according  to  Liebig's  analysis  of  the  na- 
tural water,  but  this  was  perceived  to  be  too 
weak,  and  it  failed  to  produce  purgative  action. 
Ultimately  it  was  made  thrice  the  given  strength, 
according  to  the  following  recipe  : — Sulphate  of 
magnesia,  514.92  gr. ;  sulphate  of  soda,  519.54 
gr. ;  sulphate  of  potash,  2.76  gr.  ;  chloride  of 
sodium,  39.15  gr.  ;  bicarbonate  of  soda,  15.60 
gr.  ;  water,  16  oz.  Dose,  two  ounces  and  up- 
wards. It  will  be  observed  that  the  chloride 
of  calcium  is  omitted,  but  the  proportion  is  so 
small  that  even  when  it  was  included  there  was 
no  difference  in  the  action.  This  inexpensive 
mixture,  made  for  a  penny  a  quart,  can  be 
effectually  recommended.  It  will  be  found  to 
possess  every  advantage  attributed  to  the 
natural  variety,  the  necessity  for  buying  which 
seems  to  be  done  away  with. 


24 


CANADIAN  JOURNAL 


.^Mracni. 


THE  TREATMENT   OF  EMPYEMA. 

BY    W.   B.  CHEADLE,  M.D.,  F.R.C.P. 

Physician  to  the  Hospital  for  Sick  Children,  Great  Ormond  St. ; 
Senior  Physician  to  Out-Patients.  St.  Mary's  Hospital. 

As  the  practical  outcome,  then,  of  ray  expe- 
rience of  the  treatment  of  empyema,  I  would 
ventiu-e  to  lay  down  the  following  rules  : — 

1.  To  ascertain  the  character  of  the  fluid. — 
If  pleuritic  effusion  is  accompanied  by  high 
temperature,  and  the  rise  persists  for  upwards 
of  a  week,  or  if  the  fluid  does  not  subside  satis- 
factorily at  the  end  of  three  weeks,  even  if 
there  be  no  continued  rise  of  temperature, 
ascertain  whether  pus  be  present  or  not  by 
means  of  au  exploratory  puncture.  This  is 
best  made  by  a  hypoiermic  syringe,  after  the 
manner  advocated  by  my  friend  and  colleague, 
Dr.  Barlow.  The  hypodermic  syringe  must  be 
of  sufficient  calibre  to  allow  the  passage  of  pns 
freely,  and  its  capacity  in  this  respect  may  be 
tested  by  the  passage  of  carbolised  oil,  with 
which  it  must  be  thoroughly  disinfected  before 
use.  I  have  seen  errors  in  diagnosis  arise  from 
the  imperfection  of  the  syringe,  and  its  failure 
to  extract  pus  when  abundantly  present. 

2.  The  removal  of  pus. — If  pus  be  found, 
remove  it  at  once.  About  this  there  cannot,  I 
imagine,  be  two  opinions.  Draw  off  the  pus  in 
the  first  instance  with  a  carefully  carbolised 
aspirator.  This  gives  immediate  relief,  the 
patient  improves  at  once  in  general  health,  and 
gains  strength  for  the  more  serious  opei-ation  of 
a  free  opening,  should  it  become  necessary. 
Then,  after  an  interval  of  four  or  five  days,  if 
the  amount  of  fluid  be  large,  make  a  free  open- 
ing without  delay.  Repeated  aspirations  when 
the  fluid  re-accumulates  rapidly  in  lai-ge  quan- 
tity are  utterly  inadequate  to  cure,  and  are 
disastrous  in  the  end,  for  the  fluid  eventually 
becomes  foul  in  spite  of  all  precautions.  If  the 
amount  of  fluid  be  small,  and  the  empyema 
clearly  a  limited  one,  ascertain  the  continued 
presence  of  pus  by  the  hypodermic  syringe,  and 
then  draw  it  off  by  as{>iration  a  second  time. 
This  may  be  repeated  if  the  temperature  keeps 
down,  and  there  are  no  signs  of  large  accumu- 
lation.    For  it  has  been  shown  that  one  or  two 


aspirations  will  frequently  sntlicc  tor  the  cure 
of  a  limited  enipycnui  ;  while,  on  tin;  otlnr 
hand,  a  large  one  will  cci  luinly  icnuiie  :i  in-c 
opening  in  the  end,  and  the  sooner  the  |)u.h  is 
let  out  freely  the  better. 

3.  Position  and  character  of  the  free  opening. 
— If  it  be  decided  to  make  a  free  opening,  the 
best  position  for  it,  I  am  convinced  after  many 
experiments,  is  the  one  originally  selected  by 
Trousseau — viz.,  the  sixth  or  seventh  intercostal 
space  in  the  axillary  line.  It  has  been  objected 
to  this  that  it  is  not  the  best  position  for  free 
drainage,  and  that,  as  the  chest  falls  in,  the 
proximity  of  the  ribs  to  one  another  at  this 
point  causes  them  to  press  upon  the  drainage- 
tube,  disturb  it,  and  make  the  ribs  liable  to 
necrosis.  With  regard  to  the  first  objection,  I 
may  say  I  have  never  seen  any  practical  difli- 
culty  in  emptying  the  pleura  from  this  point ; 
and  as  to  the  second,  although  it  has  some  force, 
yet  the  difliiculty  is  not  insurmountable,  and 
the  evil  less  than  many  attending  other  situa- 
tions. The  adoption  of  the  intercostal  space 
immediately  below  the  angle  of  the  scapula,  for 
example,  which  has  been  strongly  advocated,  is, 
in  my  experience,  usually  followed  by  spelling 
and  suppuration,  and  often  by  local  abscesses, 
due,  1  imagine,  to  injury  of  the  muscles  there, 
with  the  friction  and  heat  and  pressure,  caused 
by  the  patient  lying  on  his  back.  From  these 
drawbacks  the  axillary  position  is  free.  Further, 
experience  has  taught  me  to  be  content  with  a 
single  opening.  Under  proper  management, 
this  gives  perfectly  free  and  sufficient  escape  to 
the  pus,  and  the  shock  of  the  protracted  and 
severe  double  operation — a  formidable  one  in 
the  case  of  young  children — is  avoided.  The 
cases  in  which  I  have  c;iused  a  double  opening 
to  be  made  have  done  badly  throughout.  The 
wide  openings  and  counter-opening  advocated 
by  some  authorities  ai-e  dangerous  to  little 
children,  who  bear  such  free  rough  usage  ill. 
This  method  admits  of  a  lai'ger  application  to 
adults,  but  with  children  it  is  only  admissible 
in  extreme  cases  of  large  foul  accumulations. 

4.  Antiseptic  paracentesis  and  dressings. — 
The  results  of  full  antiseptic  precautions  during 
paracentesis  and  dressing  afterwards  have  been 
disappointing.  They  were  adopted  in  three 
cases,  and  all  of  them  ended  fatally.     In  one 


OF  MEDICAL  SCIENCE. 


25 


case  only  did  the  discharge  show  any  sign  of 
becoming  foul,  but  the  children  did  badly  and 
died,  two  of  meningitis  and  one  of  peritonitis 
and  pneumonia.  Whether  the  patients  became 
carbolised  by  the  frequent  use  of  spray,  or 
whether,  on  the  other  hand,  the  dressings  were 
not  repeated  with  sufficient  frequency  (every 
second  and  third  day),  to  preserve  the  absolute 
purity  of  the  pleural  cavity,  or  the  tube  became 
obstructed  by  accumulating  debris,  I  have  been 
unable  to  determine.  But  whatever  the  ex- 
planation of  the  failure  may  be,  the  results 
were  so  unsatisfactory  that  I  have  ceased  to 
require  more  than  the  use  of  carbolised  instru- 
ments, and  dressing  with  carbolised  tow,  as  pre- 
cautions against  contagion  from  without,  the 
dressings  being  changed  twic«  dailj. 

5.  Washing  out  the  cavity  with  astringent  or 
antiseptic  liquids. —  i'ormerly,  guided  by  the 
authority  of  Trousseau,  I  diligently  used  solu- 
tions of  iodine,  and  subsequently  of  carbolic 
acid,  with  the  view  of  lessening  the  discharge 
and  preserving  it  from  foulness  ;  but  my  own 
observation  has  slowly  convinced  me  that  these 
things  tend  rather  to  increase  the  discharge 
than  to  reduce  it,  and  set  up  fever  and  consti- 
tutional disturbance.  In  cases  of  foul  secretion 
some  means  of  the  kind  must  be  adopted,  and 
an  enlarged  opening  into  the  pleura,  with  free 
irrigation,  may  become  necessary.  But  in  ordi- 
nary cases  I  am  very  sure  that  such  interference 
is  most  mischievous,  and  that  the  less  the 
pleural  cavity  is  meddled  with  in  this  way  the 
better.  I  have  seen  more  than  one  patient 
suffer  from  the  nimia  cura  medici  in  this  direc- 
tion. 

6.  The  form  of  drainage-tube. — The  best  form 
of  di  ainage-tube  is,  I  think,  a  modification  of 
I  laker's  India-rubber  tracheotomy  tube.  The 
flange  prevents  the  loss  of  the  tube  into  the 
pleural  cavity — an  accident  which  has  happened 
more  than  once  with  a  portion  of  common 
tubing ;  once,  perhaps  more  often,  this  has  led 
to  a  fatal  result. 

^  7.  The  vital  importance  of  unimpeded  escape 
of  pus. — The  one  e.ssential  point  of  supreme 
importance  in  the  management  of  an  empyema 
into  which  a  free  opening  has  been  made — of 
more  importance  than  antiseptic  opening,  or 
dressing,  or  any  other  device — is  the  securing 


of  constant,  unremittiny,  free  evacuation  of  pus 
from  the  cavity.  It  is  remarkable  how  the 
retention  of  pus  for  only  a  few  hours  sends  up 
the  thermometer.  Over  and  over  again,  warned 
of  some  mischief  by  a  rise  of  temperature  and 
access  of  febrile  symptoms,  I  have  found  the 
drainage-tube,  ascertained  to  be  free  a  few  hours 
before,  blocked  by  a  plug,  or  by  a  kink  or 
twist,  or  the  impinging  of  its  inner  extremity 
against  the  pulmonary  or  costal  pleura,  or  some 
other  cause  preventing  free  outflow.  This  re- 
medied, the  temperatui'e  falls,  and  all  goes  well 
again,  as  unimpeded  discharge  is  re-established. 
In  order  to  guard  against  this  difficulty,  I  am 
in  the  habit  of  directing  the  house-surgeon  and 
ward  sister  to  examine  frequently  during  the 
day  and  night,  and  note  whether  the  tube  be 
freely  open.  In  the  early  stages  a  satisfactory 
indtx  of  patency  is  afforded  by  the  noise  of  the 
ingress  and  egress  of  air  through  the  opening 
as  the  patient  breathes.  The  temperature 
should  be  taken  every  four  or  six  hours,  and  a 
rise  of  even  one  degree  above  normal  must  be 
regarded  as  a  warning  to  examine  whether  ob- 
struction to  outflow  be  not  the  cause  of  it.  It 
is  impossible  to  exaggerate  the  importance  of 
these  precautions.  The  maintenance  of  free 
outflow  appears  to  afford  protection  against 
absorption  of  morbid  material,  probably  by 
promoting  the  removal  of  older  decaying  secre- 
tion from  contact  with  tho  absorbents.  Immu- 
nity from  such  recurrent  "poisonings,  slight 
though  they  may  be,  must,  and  does,  tell  favour- 
ably upon  the  result. 

8.  Avoidance  of  contagion. —  Patients  with 
empyema  in  which  free  openings  have  been 
made  appear  to  be  as  susceptible  to  infection  as 
puerperal  women.  Every  precaution  should, 
therefore,  be  taken  to  guard  them  against  it. 

9.  The  use  of  drugs. — With  regard  to  treat- 
ment by  drugs,  I  have  little  to  say,  except  by 
way  of  warning  against  their  too  free  use.  As 
remedial  agents  they  play  no  important  part, 
and  it  is  a  mistake  to  nauseate  patients  with 
cod-liver  oU  to  improve  nutrition,  or  with  sali- 
cylic acid,  or  large  dcses  of  quinine,  to  bring 
down  temperature.  Astringents,  or  bismuth 
with  opium,  are  useful,  and  even  necessary,  to 
control  the  diarrhoea,  which  is  often  very  trou- 
blesome  and    exhausting;    and    tonics,    with 


CANADIAN  JOURNAL 


nourishing  diet  and,  perhaps,  wine,  are  valuable 
adjuncts. 

10.  Change  of  air. —  The  one  therapeutic 
agency  which,  next  to  the  removal  of  the  puru- 
lent fluid,  possesses  great  power  for  good  in 
these  cases  is  change  to  fresh  pure  air.  I  con- 
stantly find  that  patients  who  linger  on  for 
weeks  in  a  stationary  condition  with  chronic 
discharge,  neither  better  nor  worse,  improve 
immediately  on  removal  lo  the  Convalescent 
Hospital  at  Highgate,  and  return  in  a  very 
short  time  absolutely  well.  I  remember  espe- 
cially one  poor  boy,  who,  owing  to  temporary 
closing  of  tlie  Highgate  waids,  could  not  be 
removed  there,  and  remained  for  months  in 
(Jreat  Ormond  Street,  half-cured,  but  gaining 
no  ground,  and  with  a  persistent  chronic  dis- 
charge which  threatened  ultimate  mischief.  At 
last  the  opportunity  came,  and  he  went  to 
Highgate,  to  return  in  a  very  few  weeks  per- 
fectly well. 

The  singular  success,  too,  which  attends  the 
treatment  of  empyema  in  children  in  private 
practice,  as  compared  with  that  in  hospitals,  is 
very  significant.  It  is  due  partly,  no  doubt, 
to  the  fact  that  such  cases  are  discovered  and 
treated  early,  whereas  a  large  proportion  of 
those  which  come  into  hospitals  are  of  long- 
standing, having  been  neglected,  because  tbe  dis- 
ease has  been  overlooked  or  mistaken,  and  the 
patients  more  or  less  broken  down  by  the  persist- 
ent illness.  But  the  more  favourable  hygienic 
conditions  by  which  private  patients  of  the 
better  class  are  surrounded  have  an  important 
influence  also,  while  the  many  dangers  to  which 
hospital  patients  are  exposed,  in  spite  of  all 
precautions,  from  the  aggregation  of  sick  per- 
sons, and  intercourse  with  the  contagious  and 
unclean  from  outside,  are  obvious.  It  is  a 
question  how  far  cases  of  empyema  in  hospital 
should  be  further  protected  by  isolntion  and 
special  hygienic  advantages. — London  Lancet. 

.  m^m  . 

Cleansing,  Disinfecting,  and  Preserving 
Sponges. — Sir,  —  Apropos  of  the  excellent 
sponge-bath,  made  by  Messrs.  Groom  &  Co.,  to 
which  you  called  attention  last  week,  I  should 
like  to  say  a  few  words  about  sponges.  Some 
years  ago,  when  I  was  travelling  alternately  on 
sea  and  land,   I  noticed  that   my  bath-sponge 


was  very  diff'erently  affected  by  the  fresh  water 
and  the  sea  water  which  I  used  for  my  baths. 
We  all  know  that  sponges,  after  they  have  been 
used  for  a  while  in  hard  water,  become  clogged 
with  oiganic  and  earthy  impurities,  and  lose 
much  of  their  elasticity  and  power  of  absorbing 
and  parting  with  water.  The  ordinary  domestic 
remedy  for  this  condition  is  common  washing 
soda  ;  but  this  substance,  while  effectually  re- 
moving the  impuritii'S,  destroys  the  texture  of 
the  sponge,  and  it  quickly  falls  into  pieces. 
The  preparations  of  chlorine  and  sulphurous 
acid  used  for  bleaching  and  disinfecting  sponges 
have  also  an  injurious  effect,  and  should  be 
avoided  (as  should  new  bleached  sponges,  for 
they  are  always  bad  ones)  ;  Condy's  fluid  stains, 
and  carbolic  acid  consolidates  organic  matters 
in  the  meshes  of  the  structure ;  and  they  are 
also  to  be  avoided  as  unsuitable  for  mere  clean- 
sing purposes.  I  have  found,  by  repeated  ex- 
periments, that  returning  the  sponge  to  its 
native  element,  or  what  answers  equally  well, 
steeping  it  in  strong  salt  and  water,  to  which  a 
few  gi-ains  of  iodine  have  been  added,  enables 
it  to  throw  off  its  impurities  and  to  regain  its 
normal  elasticity  and  absorbent  properties,  and 
at  the  same  time  to  become  disinfected.  The 
process  is  not  a  rapid  one ;  and  iodine  is  only 
slightly  soluble  in  salt  water  \  so  that  very 
dirty  sponges  cannot  be  purified  in  this  way, 
and  a  preliminary  washing  in  soap  and  warm 
water  may  be  necessary.  Sponges  may  be  kept 
in  this  kind  of  pickle  for  any  length  of  time 
without  injury  to  their  texture;  and  as  clean 
sponges  are  essential  to  success  in  operative 
surgery,  surgeons  and  nurses  would  do  well  to 
keep  their  sponges  in  this  manner  when  not  in 
use,  instead  of  allowing  them  to  become  dry 
and  gather  dust,  or  absorb  and  condense  im- 
pure gases.  Salt  is  one  of  the  best  antisepties, 
and  iodine  is  one  of  the  most  powerful  disinfec- 
tants, and  they  belong  to  the  element  in  which 
the  sponge  was  originally  developed.  A  bath 
sponge  which  has  been  treated  in  this  way  has 
the  pleasant  sea-side  smell  which  has  been  at- 
tributed to  the  presence  of  ozone,  but  which  is 
more  probably  due  to  iodine. — Your  obedient 
servant,  Charles  Roberts,  F.R.C.S. 

Bolton  Row,  W.,  March  3rd,  1881. 

— British  Medical  Journal. 


OF  MEDICAL  SCIENCE. 


27 


Agnew  on  Incision  of  the  Lachrymal 
Sac. — Dr.  C.  R.  Agnew  of  New  York  says 
(Detroit  Lancet)  :  The  anatomy  of  the  parts 
is  about  as  follows.  We  have  the  eyelids 
covering  the  eyeballs,  and  towards  their  inner 
angle  we  have  the  puncta.  Now,  behind 
this  angle,  which  is  called  the  internal  canthus, 
is  the  little  gland  called  the  caruncle,  and,  just 
in  the  crease  between  the  caruncle  and  the 
angle  of  the  eyelids,  there  is  nothing  between 
the  external  world  and  the  cavity  of  the  sac 
but  conjunctiva  and  sac-wall.  As  the  sac  fills 
up  with  matter,  its  anterior  wall  is  brought 
forward,  the  tendon  of  Horner's  muscle  is 
more  or  less  stretched,  and  the  sac  bulges 
below  and  above  it  and  is  made  prominent. 
Now,  standing  behind  a  patient  who  haa  such 
a  lachrymal  abscess,  which  you  are  not  able 
to  enter  through  the  punctum,  you  may  take 
Beer's  knife,  and,  holding  the  head  firmly, 
poise  the  blade  of  the  instrument  flat-wise, 
so  as  almost  to  be  in  contact  with  the  cornea, 
pass  it  behind  the  internal  canthus  behind  the 
angle  where  the  lids  come  togethei',  carrying 
the  point  inwards,  and  enter  the  sac,  reaching 
it  by  making  a  slight  wound.  This  wound 
usually  heals  rapidly,  does  not  interfere  with 
the  canaliculi,  and,  if  it  becomes  fistulous,  does 
no  possible  harm,  because  it  is  inside  of  the 
lids,  and  the  sac  empties  itself  inside,  instead 
of  outside  upon  the  cheek.  The  sac  having 
been  emptied,  it  may  be  treated  according 
to  the  indications. — London  Medical  Record. 


Seiler  on  Syphilitic  Laryngitis. — The 
author  {JVew  York  Med.  Gaz.,  May,  1881)  lays 
much  stress,  in  the  diagnosis  of  this  aflfection 
from  non-specific  inflammation  of  the  larynx, 
on  the  peculiar  carmine  discoloration  of  the 
mucous  membrane  and  the  symmetrical  dis- 
position of  the  inflammatory  patches  in  the 
syphilitic  aflfection.  Another  diagnostic  sign 
is  the  red  Hue  observed  upon  the  velum  palati. 
Dr.  Seiler  recommends  as  treatment,  besides 
the  systemic  and  supporting,  local  touching 
of  the  shallow  ulcers  with  solid  nitrate  of 
silver  fused  upon  an  aluminium  probe,  and 
of  the  deep  ulceration  with  acid  nitrate  of 
mercury  (1  to  4),  or  the  galvanic  cautery. — 
London  Medical  Record. 


Riehl  on  the  Use  of  Iodoform  in  I  upus 
Vulgaris. — This  writer  believes  {Wien.  Med. 
Woch.,  No.  19,  1881)  that  he  has  discovered  in 
iodoform  a  remedy  for  lupus  analogous  to 
mercury  and  iodine  in  syphilis,  that  is,  that 
iodoform  causes  absorption  and  transformation 
of  the  lupous  tissue.  In  the  case  of  ulcerating 
lupus  tubercles,  he  places  on  the  part  a  layer 
of  iodoform  1  to  3  millimetres  thick :  simple 
pencilling  with  glycerine  of  iodoform  is  of  no 
use.  For  deeper  infiltrations  he  first,  with 
soap,  washes  off"  all  fat  frcm  the  surface,  and 
then  pencils  the  part  with  a  solution  of  caustic 
potash  (one  to  two  by  weight  of  water)  till  the 
epidermis  is  thoroughly  removed,  after  which 
he  removes  the  supeifluous  caustic,  dries  the 
part,  and  places  on  it  a  layer  of  iodoform  1  to 
2  milliiiietres  thick.  This  he  covers  with 
cotton-wool  and  plaster,  and  leaves  for  three  to 
eight  days ;  when,  in  an  ordinary  case,  he 
expects  the  lupous  tissue  to  have  disappeared, 
leaving  slight  pits.  There  is  no  paiu,  except 
when  the  caustic  is  applied,  nor  is  thei-e  any 
suppuration.  The  process  may  have  to  be 
repeated  twice  or  thrice  in  severe  cases. — 
James  Anderson,  M.D. 


Ophthalmia  Neonatorum. — Dr.  Fancourt 
Barnes  narrates  {Brit.  Med.  Joiir.)  a  case  of 
this  aff'ection  occurring  in  a  child  born  in  the 
unbroken  membranes,  and  who  never  came  in 
contact  with  the  maternal  passages  at  all.  He 
also  cites  a  case  from  Yeit  in  a  child  delivered 
by  Csesarean  section. 


Martin  on  Parsley  as  a  Means  of  Sup- 
pressing THE  Secretion  of  Milk. — M.  S. 
Martin  reports  (Bull.  Gen.  de  Therap.,  Aug. 
30),  that,  if  the  breasts  of  a  nursing  woman  be 
covered  with  parsley  leaves  freshly  pulled,  the 
application  being  renewed  several  times  a  day, 
as  quickly  as  the  leaves  fade  the  milk  will  cease 
to  appear.  This  is  an  application  which  may  be 
used  when  it  is  impossible  to  give  purgatives 
or  other  remedies  internally. — London  Medical 
Record. 


28 


CANADIAN  JOURNAL 


€0vxt$ymAtnct, 


To  the  Editor  of  the  Canadian  Journal  of  Mbdical  Scibkcr. 

"PUERPERAL  ECLAMPSIA." 

•Sir,  —  I  beg  to  invite  your  attention  to  the 
rather  extraordinary  and  very  unsatisfactory 
exposition  of  the  etiology  of  puerperal  eclanijwia 
as  laid  down  in  ihe  initial  and  "original" 
article  in  your  issue  for  December. 

Tlie  condition  of  pregnancy  is  said  to  be  one 
in  which  the  system  is  "  burdened  with  the  extra 
work  of  suj)plying  and  developing  the  foetus." 
The  heart,  it  is  said,  "  will  necessarily  have 
more  work  to  perform  in  carrying  on  the  foetal 
as  well  as  the  general  circulation,"  and  "  the 
nervous  system  will  also  have  extra  duties 
in  contributing  to  the  development  going  on." 

Now,  the  truth  of  this  being  conceded,  does 
it  not  follow  that  an  increased  expenditure  of 
jiower  in  the  organism  is  likely  to  lead  to 
exhaustion,  rather  than  to  repletion  and  explo- 
sion, from  an  undue  accumulation  of  energy  ] 
That  would  surely  be  a  fair  and  natural  in- 
fen'nce.  And  if  it  be  further  true,  as  is  asserted 
in  the  article  referred  to,  that  "  the  labor  re- 
quired of  the  circulatory  and  nervous  systems 
increases  as  gestation  advances,"  would  it  not 
be  a  fair  presumption  that  at  the  period  of 
grettest  expenditure — the  close  of  gestation — 
there  would  be  the  least  surplus  energy  to  spare? 
And  yet  the  writer  of  the  article,  after  an- 
nouncing the  ever-increasing  expenditure  of 
nerve  power  as  gestation  advances, — the  maxi- 
mum of  such  expenditure  taking  place  just  as 
the  eclampsia  appear — adds,  "  consequently  at 
or  near  the  termination  [of  gestation]  the  ner- 
vous centres  are  worked  up  to  such  a  state  of 
tension,  if  I  may  so  express  myself,  as  to  relieve 
themselves  by  that  spasmodic  condition  called 
convulsions." 

Is  this  a  fair  presumption  to  base  on  the 
condition  of  increased  nervous  expenditure 
previously  said  to  exist  1  Is  it  really  true  that 
the  expenditure  of  a  more  than  ordinary  pro- 
poition  of  nerve  force  begets  an  accumulation 
of  nerve  force,  of  which  the  convulsions  are  the 
consequence]  Is  that  word  "  consfquently  " 
a  projjer  connecting  link  between  what  goes 
before  and  what  follows]  To  put  the  case  in 
another  light : — Were   the  boiler  of    a  steam  | 


engine  to  explode,  would  it  be  a  satisfactory 
explanation  to  allege  that  for  a  considerable 
time  more  steam  than  usual  had  been  expended 
in  the  working  of  the  engine,  and  that  in  con- 
sequence, increased  tension  had  caused  the 
explosion  ]  This  very  term  "  explosion  "  is 
very  commonly  aj)plied  to  the  action  of  the 
neivous  centres  in  convulsions  by  modern 
authors. 

We  are  told  that  during  pregnancy  the  ner- 
vpus  centres  are  continually  "relieving  them- 
selves "  by  more  than  ordinary  expenditure  of 
power,  that  this  drain  upon  them  is  increased 
as  gestation  progresses,  and  yet  that  when  their 
capacity  for  expenditure  might  be  exfMicted  to 
be  the  lowest,  they  are  necessitated  to  "  relieve 
themselves  "  still  further  to  a  highly  abnormal 
degree,  and  in  doing  so  produce  the  phenomena 
of  eclampsia ! 

This  is  most  extraordinary  doctrine ;  and  it 
is  lamentable  to  find  in  the  words  of  the  author 
of  the  article,  that  it  is  "  substantially  all  we 
know  "  on  the  subject.  Nevertheless  he  pro- 
ceeds thereupoii  to  ignore  this  knowledge,  and 
"goes  back"  upon  the  doctrine  just  enunciated. 
He  finds,  in  explaining  the  treatment,  that 
"the  increased  labor  of  the  heart  in  carrying 
on  the  foetal  circulation  might  disturb  the 
general  circulation,  and  as  a  consequence 
anaemia  of  the  l)rain  be  produced."  Now 
anaemia  of  the  brain  is  attended  by  pi-opor- 
tionately  defective  innervation ;  for  "  it  is  a 
physiological  law  that  the  functional  activity 
of  an  organ  is  diiectly  proportionate  to  the 
supp  y  of  arterial  blood  to  the  organ"  (Dr.  C. 
B.  RadclifFe,  F.  R.  S.).  Consequently  this  is 
not  a  condition  of  the  brain  in  which  augmented 
nerve  force  could  be  generated.  But  the  au'hor 
continues  :  "  In  the  second  place,  the  brain  and 
the  nerves  of  organic  vitality  become  irritated 
and  ex/musted  by  the  duties  required  of  them." 
From  this  it  would  appear  as  if  the  exhausted 
nerve  centres  need  not  discharge  extraordinary 
supplies  of  nerve  force,  in  order  to  "relieve" 
themselves.  Relief  comes  in  a  different  way, 
to  which  the  article  in  question  bears  witness. 
The  morphia  which  proves  so  useful  does  not 
relieve  the  exhausted  brain  by  depleting  it. 
On  the  contrary,  the  author  says,  "by  this  di  ug 
we  produce  an  increased  flow  of  blood  to  the 


OF  MEDICAL  SCIENCE. 


29 


nervous  centres," — furnishing  therein  the  pabu- 
lum from  which  to  generate  more  nerve  force, 
— and  he  adds,  "  in  the  second  place,  by  its 
soporific  effect  the  brain  is  allowed  to  rest 
while  increased  power  is  gained  to  carry  on  the 
nervous  functions  of  the  body."  (Italics  mine). 
This  is  an  extraordinary  way  to  relieve  the 
"  state  of  tension  "  of  the  brain, — by  causing  an 
influx  of  blood  to  it — iucrt-asing  its  power,  etc. ! 

The  writer  of  the  article  referred  to,  is  per- 
haps not  much  to  blame.  If  he  has  sinned  at 
all,  it  is  in  the  midst  of  the  most  orthodox 
medical  society.  Just  such  contradictions  and 
absurdities  abound  in  modern  medical  litera- 
ture ;  and  in  my  opinion,  are  a  disgrace  to 
modern  medical  "  science."  They  are  the  out- 
come of  a  false  theory  on  the  inter-relations  of 
nerve  and  muscle.  Fortunately  for  the  sick, 
the  theory  is  often  ignored  in  practice,  and 
spasms  and  convulsions  are  "  relieved  "  by  re- 
inforcing the  nervous  centres  rather  than  by 
adding  to  their  exhaustion.  Thus  our  best  "anti- 
spasmodics "  are  really  stimulants  (Anstie.) 

One  word  more.  It  might  be  inferred  from 
the  article  under  discussion  that  the  treatment 
of  puerperal  eclampsia  by  moiphia  was  new, 
and  that  it  originated  with  the  wiitor  of  that 
article.  This  is  not  the  case ;  a  fact  to  which 
I  merely  point,  and  on  which  I  offer  no  com- 
ment. 

Yours,  etc., 

Thomas  W.  Poole,  M.D. 

Lindsay,  Dec.  5  th,  1881. 


To  the  Editor  of  the  Canadian  Journal   of  Medical  Science. 

Sir, — I  see  that  Dr.  McKinnon,  of  Guelph, 
has,  in  your  last  issue,  been  giving  free  rein 
to  a  brilliant  and  not  over-scrupulous  imagina- 
tion. Were  it  not  for  the  last  two  paragraphs, 
I  should  not  have  troubled  you  with  a  reply. 
I  could  easily  afford  to  smile  at  the  unmanly 
allusion  as  to  ail  I  know  "  of  the  supra-pubic 
method."  The  Ontario  Medical  Association 
will,  doubtless,  struggle  to  survive  the  fury  of 
Dr.  McKinnon's  attack,  and  the  Doctor  himself 
will  be  able  to  soothe  his  ruffled  soul  by  the 
fond  delusion  that  he  discovered  a  surgical 
'*  plagiarism  "  where  none  existed.  Hugging 
his  phantom  will  do  no  harm  until  his  frenzy 
subsides. 


Dr.  McKinnon,  in  his  last  sentet.ce,  speaking 
of  me,  says  : — "  The  article  he  favoured  your 
'■  readers  wiih  is  but  a  small  affair  as  compared 
"  with  the  glowing  account  given  by  a  local 
"  paper,  in  which  we  meet  with  terms — very 
"  unfamiliar  to  other  than  professional  ears — 
"  from  the  use  of  which  its  origin  may  be 
"  inferred." 

The  doctor  did  not  come  out  boldly  and 
charge  me  with  being  the  author  of  the 
"  glowing  account."  He  insinuates  what  he 
dare  not  say,  and  his  insinuation  is  utterly 
false.  I  neither  wrote  the  article  nor  caused 
it  to  be  written,  and  in  proof  of  this  I  append 
CO  pits  of  certificates  from  both  the  "local" 
Guelph  pa|)ers. 

"  Office  of  the  '  Guelph  Daily  and  Weekly  Herald.' 
"Guelph,  Dec.  7th,  1881. 
"  To  whom  it  may  Concern. 

"  I  never  received  any  information  from  Dr.  Groves, 
of  Fergus,  regarding  an  operation  performed  on  William 
Hood  or  any  other  person.  My  information  in  the 
case  of  William  Hood  was  given  to  me  by  a  member 
of  the  family. 

"H.  E.  Smallein.     [A.G.]" 

"Office  of  the  ^Mercury  and  Advertiser.' 
"Guelph,  Dec.  7th,  1881. 
"  To  whom  it  WMy  Concern. 

"  We  hereby  certify  that  Dr.  Groves,  of  Fergus,  did 
not  furnish  to  vis  any  particulars  whatever  of  the 
operation  performed  by  him  on  Mr.  William  Hood  in 
April  last.  The  facts  of  the  case  were  furnished  to 
us  by  a  member  of  the  family,  and  the  doctor  knew 
nothing  of  the  matter  until  after  the  publication  of  the 
notice. 

"Innes  &  Davidson." 

Dr.  McKinnon  says  that  Dr.  Groves  gives 
"  his  method  of  operating,  after  treatment, 
and  results."  The  truth  is  I  did  not  use 
the  possessive,  and  Dr.  McKinnon  knew  I  did 
not,  for  he  read  the  article  "carefully  over." 
What  I  did  was  to  write  a  plain  and  simple 
account  of  a  couple  of  cases  which  I  treated 
as  hundreds  had  been  treated  before.  This 
account  had  never  been  written  before,  there- 
fore I  could  not  plagiarize  it.  It  is  well 
the  doctor  has  the  candour  to  admit  that  my 
article  was  "  refreshing,"  and  I  hope  he  found 
it  sufficiently  so  to  prevent  his  "  apprehension  " 
becoming  more  "serious." 

I  remain,  yours  truly, 

A.  Groves. 

Fergus,  Dec.  8th,  1881. 


30 


CANADIAN  JOURNAL 


To  the  Editor  of  the  Canadiah  Jourhal  op  Mbdical  Scikncb. 

AN  EXPLANATION. 

Sir, — In  tlie  last  number  of  your  respected 
Journal,  I  perceived  that  I  had  given  mortal 
offence  in  some  of  the  remarks  I  made  at  the 
Annual  Dinner  of  the  Students  of  Trinity  Col- 
lege. [Medical  School  (1) — JSd.]  I,  among  many 
others,  was  honoured  with  a  very  kind  invi- 
tation to  attend.  After  dinner  a  number  of 
toasts  were  proposed  and  responded  to. 

When  the  toast  of  the  Ontario  Medical  Coun- 
cil wa.s  proposed,  I  had  the  honour  of  being 
called  upon  for  a  reply,  to  which  I  most  reluc- 
tantly agreed.  Not  being  in  the  best  of  health 
at  the  time,  I  had  but  little  to  say — so  I  said  it. 
Memory  fails  to  admonish  me  as  to  what  1  did 
siy,  until  1  saw  a  report  of  the  proceedings  in 
your  journal.  I  ana  reported  as  saying,  that  I 
thought  a  two  yeai-s'  term  was  long  enouuh  for 
the  examiners  to  be  appointed,  and  also  that  I 
regretted  the  appointment  of  one  '*  examiner," 
I  am  further  charged  with  using  the  epithets 
in  my  regret,  "one  examiner,  you  know  who," 
Of  this  I  make  no  denial,  although  I  cannot 
recollect  the  fact.  In  your  strictures  on  the 
occasion  referred  to,  you  state  "  that  it  was 
simply  contemptible  to  make  such  an  attack 
upon  any  man  where  neither  he  nor  his  friends 
were  in  a  position  to  resent  it,"  Now,  sir,  you 
will  readily  admit  that,  as  a  general  rule,  where 
any  insult  is  intended,  we  at  once  associate 
with  the  act  an  inherent  malicious  intent. 
Words  uttered,  however  offensive  they  may  be, 
\mder  one  set  of  circumstances  might  be  re- 
garded as  harmless — while  under  another  state 
of  things,  the  construction  put  upon  the  same 
language  might  call  forth  strong  feelings  of 
resentment,  where  the  person  impugned  might, 
with  great  propriety,  demand  explanations  for 
insults  offered,  whether  direct  or  implied,  that 
have  been  inconsiderately  given.  Let  us  view 
this  case  under  these  aspects. 

Please  tell  me  what  had  the  examiner  or  his 
friends  to  resent  1  I  never  in  my  life  saw  the 
gentleman,  and  Kcarcely  ever  h^ard  of  him, 
until  after  his  appointment,  nor  have  I  ever 
had  any  dealings  or  correspondence  with 
him. 

You  surely  cannot   assume  that  I  had  any 


malicious  feeling  towards  him,  as  I  knew 
nothing  of  him.  You  certainly  cannot  ignore 
the  fact  that  a  petition  from  the  students  was 
presented  to  the  Council  containing  remarks 
not  of  the  most  favourable  character  to  him  as 
an  examiner.  Whether  true  or  false,  I  desire 
not  to  affirm.  I,  in  common  with  other  mem- 
bers of  the  Council,  advised  the  students  to 
withdraw  the  petition,  and  gracefully  submit 
to  the  ruling  of  the  Council — having  assured 
the  young  men  that  their  c  ise  would  be  favour- 
ably considered  ;  but  in  this  I  was  somewhat 
disappointed.  Acting  on  the  advice  given,  the 
petition  was  withdrawn.  Now,  >  r.  Editor, 
was  there  any  malice  in  this,  and  where  the 
grounds  for  resentment  1 

You  may  also  remember  the  pointed  letters 
that  appeared  in  the  public  newspapers  from 
various  parts  of  the  Province  reflecting  sadly 
not  only  on  the  character  of  the  questions  put, 
but  also  on  the  ethics  displayed  at  the  examin- 
ing board.  During  the  year  that  I  had  the 
honour  of  being  President  of  the  Council,  I  I'e- 
ceived  many  letters,  both  from  students  and 
graduates  of  the  several  medical  schools  of  the 
country,  urgently  soliciting  my  influence  against 
the  re-appointment  of  "  the  examiner,  you 
know  who."  I,  by-the-bye,  rt;ceived  one  from 
Kingston,  with  a  request  that  I  should  present 
a  petition  to  the  Council  in  the  same  direction. 
All  of  which  I  respectfully  declined — giving  as 
my  reason,  that  the  candidates  should  be  better 
prepared  for  the  ordeal.  Again,  was  there 
anything  "  contemptible "  in  this,  or  had  we 
better  "  resent"  it? 

Once  more  let  me  ask,  ''•hat  has  been  the 
result  of  this  denial  of  a  hearing  to  the  students 
and  the  ever-memorable  discussion  in  the  Coun- 
cil thereon.  Look  at  the  number  of  our  young 
men  at  the  jiresent  moment,  who  have  gone  to 
England  for  their  registration,  who  shortly 
will  return  to  practise  in  their  native  Province 
without  the  agency  or  leave  of  our  Board  of 
Examiners.  We  have  ourselves  to  blame  for 
this  exodus  from  our  own  institutions. 

■^  ithout  meaning  any  offence  in  the  fore- 
going remarks, 

I  have  the  honour  to  be,  &c,, 

VV.   Allison, 
Bowmanville,  12th  Dec,  IbSL 


of  MEDICAL  SCiENCfi. 


81 


To  the  Editor  of  the  Canadian  Jodrnal  of  Mbdical  Scibncb. 

Sir, — From  the  remarks  you  made  in  regard 
to  my  letter  in  your  last  issue,  evidently  you 
have  misapprehended  my  meaning.     I  did  not 
assert  that  Dr.  Groves  professed  to  be  describ- 
ing ''  his  operation  "  for  supra-pubic  lithotomy 
as  an  original  operation,  but  merely  that  the 
"  method  of  operation,"  as  pursued  in  his  case, 
was  original.      So  that  I  might  convey  a  coi-- 
rect  idea,  I  gave  his  own  words,  excepting  that 
for  the  sake   of  brevity  I  substituted  the  word 
"his"  for  "</ie,"  without  intending   to  make, 
and  in  reality  not  making,  the  slightest  altera- 
tion   in    the  meaning  conveyed.     You    aflSirm 
that  the  description  given  by  Dr.  Groves  might 
as  well  be  called  a  plagiarism  of  that  given  by 
Erichsen,    Bryant,     Ashurst,     Hamilton,    and 
_  others,    as  of   that  by  Dr.   Dulles.     True,  no 
doubt,  all  descriptions  of  the  operation  are  ne- 
cessarily much  alike ;  and  it  is  also  true  that 
any  one  possessed  of  even  a  modicum  of  com- 
mon sense,  could  embody  the  whole  idea,  and 
yet    so  vary  the   language  as    to  destroy   the 
identity.     I  did  not,  however,  base  the  charge 
I  made  on   the  similarity  of  language,  nor  on 
any  inference. 

The  authors  you  mention,  as  well  as  all  sur- 
gical writers  of  any  note,  so  far  as  I  know, 
condemn  the  supra-pubic  operation,  and  they 
quote  statistics  to  show  that  the  rate  of  mor- 
tality is  high  (1  in  3  or  4,  while  in  the  lateral 
operation  it  is  only  1  in  11),  But  Dr.  Dulles, 
in  the  article  referred  to,  shows  that  in  regard 
to  this  operation,  statistics  lead  to  false  con- 
clusions ;  because  it  has  very  generally  been 
performed  as  a  last  resort,  frequently  after 
failing  by  the  lateral  method,  on  account  of  the 
size  of  the  stone,  or  some  abnormal  condition 
of  the  pelvis.  He  also  shows  that  there  is 
absolutely  no  danger  from  hemorrhage,  and 
that  it  cannot  be  followed  by  impotence  or  in- 
continence of  urine,  as  sometimes  follows  the 
lateral  operation.  He  claims  that  the  supra- 
pubic is  a  himpler  and  safer  method  than  the 
lateral,  and  maintains,  justly,  I  think,  that 
under  exactly  similar  conditions  it  will  give 
much  better  results  than  its  more  popular  rival. 
No  doubt  Dr.  Groves  had  access  to  all  the 
works  you  name,  and  though  he  had  his  first 
case  under  care  for  several  weeks,  he  had  de- 


cided not  to  operate  at  all.  The  careful  perusal 
of  the  article  by  Dr.  Dulles  led  him  to  change 
his  decision,  and  a  few  days  afterwards  he  i)er- 
formed  the  supra-pubic  operation.  A  few 
weeks  later  he  went  to  Toronto,  and  read  before 
the  (Ontario  Medical  Association  a  paper  giving 
"  the  method  of  operating,  after-treatment,  and 
results."  He  said,  "  The  ordinary  text-books 
give  no  explicit  directions ; "  but  he  never 
mentions  even  the  name  of  Dulles,  though  the 
perusal  of  the  article  unquestionably  led  him 
to  prefer  the  high  operation. 

Briefly,  then,  is  it  not  plagiarism  when  a 
writer  says  he  :;an  get  no  description  in  the 
ordinary  works,  etc.,  then  gives  a  description 
which  he  himself  got  from  a  work  less  known, 
allowing  his  readers  to  infer  that  it  was^is 
own  production  1 

Regarding  the  supra-pubic  operation,  I  mny 
say,  in  conclusion,  1  am  convinced  that  in  the 
hands  of  ordinary  practitionei*s  it  will  give 
better  results  by  far  than  either  lateral  litho- 
tomy or  lithotrity. 

Yours  respectfully, 

Angus  McKinnon, 
Guelph,  Dec.  12th,  1881. 


To  the  Editors  of  the  Canadian  Journal  of  Mbdical  Scibncb. 

Gentlemen, — In  the  December  number  of 
your  .lournal,  you  refer  editorially  to  my  speech 
at  the  late  Trinity  Medical  School  Dinner. 

In  one  point,  I  am  sure  quite  unintentionally, 
you  entirely  misrepresent  what  I  said,  which 
was  to  this  efiect,  that  I  agreed  with  a  great 
deal  of  what  Dr.  Allison,  the  venerable  and 
kind-hearted  ex-President  of  the  Council,  had 
said  in  his  speech.  But  I  never  referred  to 
the  Examiners  appointed  by  the  Council  for 
the  present,  nor  to  those  of  any  year — I  was 
not  even  thinking  of  them.  I  have  every  con- 
fidence in  the  Board  of  Examiners,  and  am  per- 
fectly satisfied  that  all  its  members  will  do 
their  duty  fairly  and  well.  Since  reading  your 
article,  I  have  taken  the  trouble  to  ask  several 
medical  gentlemen  who  were  present  at  the 
dinner,  and  without  exception  they  corroborate 
my  own  recollection  in  this  particulai'. 

The  other  points  you  refer  to  require  only  a 
very  brief  reply.  In  your  issue  of  July  last, 
referring  also  editorially  to  some  of  the  Ian- 


S2 


CANADIAN  JOURNAL 


guage  used  in  certnin  speeclies  made  at  tJie 
late  Council  Meeting,  you  said  Lh<«t  it  was 
"  neither  jiist,  manly,  nor  (Hgnijied."  This  was, 
and  is,  exactly  my  own  view — and  it  is  ox- 
pressed  just  as  strongly  as  I  spoke,  in  referring 
to  the  very  same  language  at  our  dinner.  And 
certainly,  at  our  own  table,  with  none  present 
in  addition  to  the  class,  but  our  invited  guests, 
and  without  even  the  faintest  suspicion  that 
any  one  at  the  table  would,  or  even  could,  im- 
pute any  unwo»thy  motive  as  influencing  any 
remarks  which  might  be  made.  Under  such 
circumstances,  I  had,  I  submit,  a  perfect  right 
— nay,  I  deemed  it  my  hounden  duty  to  the 
class  and  to  the|_Council  to  say  what  I  thought 
might  tend  in  any  degree,  however  slight,  to 
prevent  the  recurrence  of  what,  in  my  opinion, 
had  done  the  Council  very  serious,  but  I  hope 
not  irremediable  harm. 

You  complain  of  my  referring  to  the  lan- 
guage or  policy  of  public  men  in  their  absence. 
This  you  must  know  is  done  every  day.  Only 
the  other  day,  at  a  banquet  given  in  his  honour 
in  Toronto,  one  of  our  ablest  political  leaders 
did  so  without  stint,  and  no  paper  in  the 
country  thought  of  this  as  furnishing  any 
ground  of  complaint. 

You  suggest  that  1  should  have  spoken  out 
more  strongly  when  the  Council  was  in  session. 
This  is  a  matter  of  opinion.  And  now,  after 
the  lapse  of  several  months,  I  look  back  with 
satisfaction  at  having  stated  my  views  calmly 
and  quietly  at  that  time,  instead  of  having  al- 
lowed myself  to  be  carried  away  by  the  storm 
of  bitterness  which  prevailed,  and  which  you 
now  criticize  me  for  deploring. 

Walter  B.  Geikie. 

Toronto,  December,  1881. 

«  ■»■  • 

Prof.  Nikolaus  PirogofF,  of  St.  Petersburg, 
is  dead.  He  was  author  of  a  valuable  treatise 
on  Division  o^  the  Tendo-Achillis  in  Ortho- 
paedic Surgery,  a  work  on  Cholera,  on  the 
Surgery  of  the  Arter'al  Trunks  and  Fuscioe,  an 
Atlas  of  Topographical  Anatomy  from  frozen 
sections,  a  Medical  History  of  tlie  Crimean  and 
Circassian  Campaigns,  a  report  on  the  Military 
Hospitals  in  Germany  aiul  Alsace- Lorrain  dur- 
ing the  war  of  1870,  and  of  the  method  of 
partial  amputation  of  the  foot  which  bears  his 
name. 


THE  CANADIAN 


mirniii  dI  Htlirai  \{\mt, 

A  Monthly  Journal  of  Medical  Science,  Criticism, 
and  News. 


To  Correspondents. —  JVe  shall  be  glad  to  re- 
ceive from  our  friends  everywhere,  current  medical 
news  oj  s^eneral  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwat'din^  reports  of  the  proceedings  of  their 
Associations. 


TORONTO,  JANUARY,  1882. 


THANKS. 

It  gives  us  great  pleasure  at  the  commence- 
ment of  the  year  to  return  our  sincere  thanks 
to  our  good  friends  who  hav^;*  done  so  much  for 
us  during  the  year  that  is  just  completed,  by 
saying  kind  words  for  us,  and  by  recommending 
the  Journal  to  the  professional  public  in  such 
a  way  that  the  circulation  has  very  largely  in- 
creased, and  is  now  incrnasing  with  a  rapidity 
that  has  never  been  known  in  its  past  history. 
We  may  go  futher  and  say  that  its  success  in 
this  respect  has  never  been  equalled  in  the  his- 
tory of  Medical  Journalism  in  Canada.  We 
hope  that  we  shall  still  retain  the  goodwill  of 
our  subscribers  to  such  an  extent  that  they 
may  be  able  to  assist  us  even  more  than  ever 
before,  and  be  the  means  ol  adding  many  new 
names  to  our  subscription  list  during  the  year 
1882.  It  would  be  quite  easy  for  each  of  our 
friends  to  induce  one  or  more  to  take  the 
Journal,  and  the  i-esultin  the  aggregate  would 
add  greatly  to  our  strength  and  opportunities 
for  usefulness  to  the  profession.  We  have  also 
to  thank  our  m-^ny  able  contributors  for  tlieir 
valuable  communications  which  have  done  so 
much  to  increase  the  popularity  of  the  Cana- 
dian Journal  op  Medical  Science.  The 
encouragement  we  have  received  will  impel  us 
to  make  greater  exertions  to  deserve  the  gener- 
ous sujipoi  t  of  all  our  patrons.  To  one  and  all 
our  readers  we  tender  the  compliments  of  t'uis 
festive  season  with  the  wish  that  the  new  year 
may  in  all  respects  be  a  most  happy  one. 


OF  MEDICAL  SCIENCE 


33 


DR.    GEIKIE'S    SPEECH    AT   TRINITY 
MEDICAL  SCHOOL  DINNER. 

We  publish  with  pleasure  in  another  column 
of  this  issue,  Dr.  Geikie's  letter,  which  gives 
his  own  version  of  his  reference  to  the  remarks 
of  a  previous  sj»eaker,  respecting  the  appoint- 
ment of  one  of  the  Examiners  of  the  Ontario 
Medical  Council.  We  thought  that  any  serious 
mistake,  such  as  the  Doctor  has  pointed  out, 
was  impossible  because  the  remarks  were  taken 
down  at  the  time  of  their  utterance,  and  not 
written  from  memory ;  but,  notwithstanding 
this,  we  must  consider  the  question  as  finally 
settled  by  the  following  sentence  which  ap})ears 
in  his  letter,  "  I  have  every  confidence  in  the 
Board  of  Examiners,  and  am  perfectly  satisfied 
that  all  its  members  will  do  their  duty  fairly 
aud  well."  We  must  accept  this  statement 
without  reserve,  and,  at  the  same  time  have  to 
congratulate  the  Examiners,  especially  the 
"  one,"  upon  this  frank  and  generous  expression 
of  confidence  from  one  who  expressed  very 
different  opinions  a  few  months  ago. 

The  Doctor  has  erred  in  saying,  we  "  com- 
plain of  his  reitiring  to  the  language  or  policy 
of  public  men  in  their  absence."  We  referred 
simply  to  the  remarks  on  the  appointment  of 
"one  examiner,  you  know  who,"  and,  as  we 
supposed,  the  endorsation  of  these  remarks  by 
Dr.  Geikie  ;  and  we  hope  he  will  not  assert  that 
medical  men  placed  iu  the;  responsible  and  j udicial 
positions  of  examiners,  are  to  be  regarded  in  the 
light  of  public  men,  liable  to  be  criticised  and 
abused  at  public  dinners,  or  public  gatherings 
of  any  description.  As  regards  his  attack  on 
the  President  of  the  Medical  Council,  we  did 
not  question  his  right  to  criticize  the  conduct 
of  that  gentleman,  but  simply  deplored  his 
want  of  judgment  in  choosing  such  an  occasion 
for  the  expression  of  his  views,  especially  after 
he  had  neglected  a  much  more  suitable  oitpor- 
tunity  of  doing  so  in  the  midst  of  that  "storm 
of  bitternet^s  "  to  which  he  refers,  and  which 
was  so  largely  due  to  his  owu  euergt  tic  denun- 
ciations of  the  actions  of  one  of  the  examiners 
before  the  meeting  of  the  Council,  influencing, 
as  they  did  greatly,  the  lone  of  the  petition 
presented  by  the  students,  and  the  letters  which 
appeared  in  the  lay  newspapers.     As  far  as  the 


Council's  President  is  concerned,  we  are  not 
alarmed,  but  rather  feel  assured  that  he  will  be 
quite  able  to  answer  any  attacks  from  such  a 
source,  without  exhibiting  ai-y  serious  symptoms 
of  "  exhaustion." 

The  insinuation,  that  \'e  abused  the  generous 
hospitality  of  the  Trinity  Faculty  and  students 
by  sitting  down  at  their  "  own  table,  and  at  the 
same  time  imputing  unworthy  motives,"  etc.,  is 
too  absurd  to  inflict  a  deep  wound  or  call  for  a 
lengthy  reply,  as  every  one  knows,  the  Doctor 
himself  included,  that  it  was  a  public  dinner 
with  guests  representing  all  the  various  classes 
of  the  community,  and  we  ourselves  were 
invited  to  represent  the  press,  particularly  this 
Journal,  with  the  expectation  that  we  would 
report  as  fully  and  fairly  as  possible  all  the 
proceedings,  and  surely  this  included  the  right 
to  comment  upon  the  speeches  thus  given  to  the 
public.  If  we  adopted  any  other  view,  and 
allowed  the  speakers  the  privilege  of  criticizing 
the  acts  of  others  without  granting  any  right 
of  reply,  we  could  only  regard  any  attacks  on 
outsiders  as  cowardly  in  the  extreme,  and  we 
would  certainly  feel  very  soi  ry  to  be  forced  into 
the  position  of  making  such  a  charge  against 
the  honorable  Dean  of  this  prosperous  Medical 
Institution,  whose  deep  interest  in  the  welfare 
of  his  students  is  well  known,  but  whose  zeal 
unfortunately  is  not  always  tempered  with  the 
best  judgment. 


Erratum. — In  the  obituary  notice  of  Dr. 
David  Foulis  of  Glasgow,  in  our  last  issue, 
it  was  stated  that  he  was  the  discoverer  of  the 
microscopic  evidences  of  malignancy  in  ovarian 
fluids.  Dr.  Archibald  Malloch  of  Hamilton, 
who  was  personally  acquainted  with  Dr.  Foulis, 
writes  us  to  say  that  he  thinks  we  were  in 
error  in  that  particular,  and,  on  referring 
to  Foulis's  original  paper  on  the  subject,  we 
find  such  to  be  the  case,  and  that  the  credit 
of  this  discovery  is  due  to  Dr.  James  Foulis, 
of  Edinburgh.  True  to  the  maxim,  "  De 
tnortuis  rdl  nisi  verum,"  and  actuated  by  a 
desire  for  scrupulous  exactness  in  all  state- 
ments contained  in  these  columns,  we  are 
much  indebted  to  Dr.  Malloch  for  kindly 
directing  attention  to  our  mistake. 


34 


CANADIAN  JOURNAL 


THE  STUDENTS  AND  THE  POLICE 
FORGE  OF  TORONTO. 

We  regret  exceedingly  to  find  that  a  bad 
feeling  is  growing  up  between  the  students  and 
the  policeuien  ot  this  city.  It  commenced  by 
a  collision  between  the  students  ot"  the  Toronto 
School  of  Medicine  and  the  force,  while  the 
former  were  walking  home  from  their  annual 
dinner,  when  some  stupid,  ill-natured,  and 
officious  "  guardians  of  the  peace,"  without  any 
provocation,  attacked  them  with  their  batons, 
and,  had  it  not  been  for  the  presence  of  Drs. 
Richardson  and  Graham,  who  managed  to  cool 
the  ardour  of  these  bold  warriors,  the  conse- 
qiiences  might  have  been  very  serious.  Since 
that  time  some  foolish  students  of  various 
departments  have  transgressed  the  laws,  and 
two  have  been  fined  by  the  Police  Magistrate 
for  their  cflFences,  and  a  determined  hostility 
exists  between  the  two  parties.  The  stu- 
dents now  band  together  and  apparently 
endeavour  while  walking  along  the  streets 
to  tantalize  the  "  bobbies,"  without  actually 
br(  aking  the  peace,  while  the  latter  accompany 
the  young  men,  in  their  nightly  promenades, 
evidently  thirsting  for  an  opportunity  of  seiz- 
ing and  "  running  them  in." 

If  this  unequal  contest  continues,  there  can, 
of  course,  be  only  one  result :  the  policemen, 
with  the  law  on  their  side,  must  win,  the 
students  must  lose  and  suffer  serioiisly  at  the 
same  time.  While  we  thoroughly  sympathize 
with  these  young  men  as  far  as  the  infamous 
action  of  the  first  "  clubbers  "  is  concerned,  we 
sincerely  hope  that  they  will  cease  their  en- 
deavours to  annoy  the  police  and  the  citizens  of 
Toronto  by  marching  along  the  streets  in 
crowds,  and  singing  at  unseemly  hours  of  the 
night.  Their  friends  (and  they  are  many)  are 
very  anxious  that  such  conduct  be  stopped  at 
once  before  acts  are  done  which  will  cause  them 
serious  trouble  and  disgrace. 

While  we  cannot  always  approve  of  every 
act  of  the  students,  we  must  do  them  simple 
justice,  and  say  that,  apart  from  the  occasional 
foolish  pranks  of  an  exceptional  few,  they  act 
generally  in  a  very  orderly  manner,  and,  are  as 
a  class  too  thoroughly  in  earnest  to  waste  their 
time  in  nightly  carousals  as  some  people  seem 


to  think  the  majority  are  accustomed  to  do. 
While  most  of  them  come  from  the  rural  dis- 
tricts, and  are  perhaps  not  so  dapper  in  appear- 
ance as  our  city  dandies,  still  at  the  same 
time  they  re,  taken  altogether,  immeasurably 
superior  to  the  short-coated,  tight-trowsered 
fops  who  delight  to  do  King  Street,  and  we  ho{)e 
that  our  citizens  will  not  exaggerate  the  follies 
of  the  few,  but  rather  extend  a  generous  wel- 
come to  all  the  students  who  come  among  us 
as  stmngers,  and  treat  them  with  kindness  as 
long  as  they  remain  with  us. 


THE    MEDICAL     SOCIETY    OF    THE 
TORONTO  SCHOOL  OF  MEDICINE. 

We  are  much  pleased  to  learn  that  the 
Faculty  and  Students  of  this  Institution  have 
organized  an  Association  to  be  known  as 
the  "  Toronto  School  of  Medicine  Medical 
Society,"  which  will  hold  regular  meetings 
during  the  sessions,  at  which  original  or  se- 
lected papers  will  be  read  on  medical  bubjects, 
together  with  discussions  on  the  papers,  and 
opportunities  will  be  afforded  for  the  presenta- 
tion of  pathological  specimens  and  patients. 
In  fact,  it  will  be  conducted,  as  far  as  practi- 
cable, after  the  manner  of  ordinary  scientific 
medical  societies..  From  the  unusual  ability 
shown  by  many  of  the  students  of  this  school, 
and  from  the  great  enthusiasm  which  has  been 
manifested  by  those  concerned  in  the  organiza- 
tion, we  can  confidently  predict  the  most  signal 
success. 

The  School  Faculty  has  kindly  placed  a 
room  at  the  disposal  of  tl.e  Society  and  fur- 
nished it  with  all  the  requirements  of  a  reading 
room  and  librai*y. 

The    following    have    been    appointed    the 
officers  in  the  Society :  President,  Dr.  A.  H. 
Wright ;  1st  Vice-President,  Mr.  J.  T.  Duncan 
2nd  Vice-President,  Mr.  W.  C.  Cuthbertson 
Treasurer,    Mr.  J.   W.  Patterson,    B.A. ;   Re 
cording    Secretary,    Mr.    F.   J.   Dolsen,   B.A. 
Corresponding  Secretary,  Mr.  G.  W.  Clendenan 
Library    Director,    Mr.     S.     Stewart,    B.A. 
Council,   Messrs.    W.    J.    Robinson,    W.    H. 
Montague,  W.  A.  Richardson,  R.  Elliott,  and 
W.  H.  Aikins,  B.A. 

An  open  meeting  of  the  Society  will  be  held 


OF  MEDICAL  SCIENCE. 


?.5 


oil  Satimlay  evtriiiug,  Jaiiuiiy  l+tli,  wht-ii  the 
president  will  deliver  his  inaugural  address, 
aud  a  discussion  will  follow  on  the  subject 
of  "  the  Causes  of  the  present  Epidemic  of 
Typhoid  Fever,"  which  will  be  opened  by 
Mr.  W.  H.  Montague. 


Therapeutics. — It  is  acknowledged  on  all 
hands  that  in  recent  years  we  have  made  won- 
derful advances  in  scientific  medicine,  but  at 
the  same  time  the  very  im{)ortant  question 
arises,  has  our  practical  knowledge  in  the  treat- 
ment of  diseases  increased  at  a  proportionate 
rate?  It  has  been  charged  that  the  tendency 
of  the  times  is  to  cultivnte  the  science  of  our 
profession  at  the  expense  of  the  art,  and  that 
many  modern  physicians  who  have  achieved 
success  in  scientific  investigations  are  less  skil- 
ful as  practitioners  than  a  large  proportion  of 
their  brethren,  who  make  no  prt-tentions  of 
possessing  deep  and  scientific  knowledge. 
While  there  may  be  some  truth  in  such  allega- 
tions in  exceptional  cases,  we  should  be  sorry 
to  think  that  on  the  whole  our  capacities  for  the 
skilful  treatment  of  all  diseases  are  not  vastly 
increased  by  the  results  of  scientific  study.  At 
the  same  time  we  fully  appreciate  the  great  im- 
portance to  the  practising  physiciap  of  a 
thorough  knowledge  of  therapeutics,  and  are 
happy  to  say  that  Dr.  R.  Macdonnell,  of  Mon- 
treal, has  kindly  promised  to  give  us  a  series  of 
papers  on  the  subject,  the  first  of  which  appears 
in  this  issue.  From  an  intimate  knowledge 
of  this  gentleman's  abilities  and  judgment,  we 
can  promise  that  these  articles  will  give  valu- 
able information  on  all  new  (or  comparatively 
new)  remedies  which  have  been  proved  without 
doubt  to  possess  therapeutic  virtues,  but  at  the 
same  time  will  contain  no  allusions  to  any 
medicines  which  are  not  likely  to  be  found 
useful  in  the  practice  of  either  town  or  country 
practitioners. 


Dr.  J.  R.  Jones,  recently  from  London, 
Eng  ,  formerly  a  student  of  the  Toronto  School 
of  Medicine,  has  settled  in  Winnipeg,  and  gone 
into  partnership  with  Dr.  J.  W.  Good,  who 
was  also  a  student  of  the  T.  S.  M. 


PkOFESSIONAL.  FtES  FOR  ATTE>DANC*E  i.N  TUB 

Late  President  Garfield. — We  have  heard  a 
gi  eat  deal  about  the  question  of  fees  for  })ro- 
fessional  attendance  in  this  remtrkable  case, 
especially  from  the  secular  press  of  the  United 
States,  but  we  now  learn  that  the  papers  had 
no  data  upon  which  to  found  their  learned  dis- 
cussions, as  no  formal  bills  have  been  presented, 
and  we  have  the  authority  of  the  New  York 
Medical  Record  for  saying  that  none  is  likely 
to  be  rendered.  According  to  this  journal, 
President  Garfield  should  be  considered  as  the 
Nation's  patient,  and  as  the  surgeons  in  chaige 
were  called  upon  to  make  great  sacrifices,  and 
did  so  willingly,  they  should  receive  a  very 
respe  ;table  honorarium,  and  while  the  United 
States  cannot  follow  the  example  of  older 
countries  under  similar  circumstances,  by  be- 
stowing titles,  the  reprepentativf  s  of  the  people 
in  Congress,  should  return  thanks  officially  to 
all,  including  the  citizen  suigeons,  and  at  the 
same  time  confer  promotions  upon  the  military 
officers  in  attendance. 


Our  Book  Reviews — We  regret  that  pres- 
sure on  our  space  (although  incre^ts^d  by 
several  pages)  compels  us  to  hold  over  our 
book  reviews  until  next  month,  when  we  hope 
to  notice  Charcot  on  Diseases  of  Old  Age, 
Holmes's  System  of  Surgery  (Vol.  II.),  Hart- 
shorne's  Essentials,  Foster's  Physiology,  Bulk- 
ley's  Eczema,  Lusk's  Midwifery,  and  Smith's 
Diseases  of  Children. 


Prof.  Busch,  of  Bonn,  is  dead.  He  was  one 
of  the  few  German  surgeons  who  completed 
their  education  by  study  in  Great  Britain,  and 
his  practice  was  decidedly  English  in  its 
characteristics. 


Mr.  H.  N.  Moseley,  M.A.,  F.R.S.,  Assistant 
Registrar  of  the  University  of  London,  suc- 
ceeds the  late  Professor  Rolleston  in  the 
Linacre  Pi'ofessorship  of  Physiology  at  Oxford. 


Robert  Dwyer  Lyoni,  M.D.,  M.P.,  is  the 
Crown  nominee  to  the  General  Medical  Council 
of  Great  Britain  in  succession  to  the  late  Di. 
A.  H.  McOlintock, 


36 


CANADIAN  JOURNAL  OF  MEDICAL  SCIENCE. 


Mr.     Eiasmua    Wilson,     President    of    the 

Royal  College  of  Surgeons,  and  Mr.  William 

MacCormac  have  been  knighted,  as  also  Dr. 

John  Kirk,  Her  Majesty's  Agent  and  Consul- 

General  at  Zanzibar,  and  Geo.  Bird  wood,  M.D., 

C.S.I.,  Assistant  Reporter  in  Statistics,  India 

Offica 

■  ■< ■ « 

Dr.   Joseph   Lewis   Pancoast,   eldest  son   of 

Dr.  W.  H.  Pancoast,  of  Philadelphia,  died  in 

Novemb  r. 

»  ■♦*  « 

Dr.  W.  J.  Wilson  has  i-eraoved  from  Stoufl- 
ville  to  Toronto,  and  is  living  on  Rose  Avenue. 


gaok  ^otUt$. 


Atlantic  City   as  a    Winter   Health  Resort. 
By  BoARDMAN  Reed,  M.D.,  Atlantic  City,  N.J. 

Vick's   Floral   Guide,  1882.     James    Vick, 
Rochester,  N.Y. 


Transactions  of  the  Michigan  State  Medical 
Society  for  1881.     No.  1.     Vol.  VIII. 


Ninety-Ninth  Anntuxl  Catalogue  of  the 
Medical  School  (Boston)  of  Harvard  Univer- 
sity, 1881-82. 


Recent  Progress  in  Surgery.  Report  to  the 
Wisconsin  State  Medical  Society.  By  N.  Senn, 
M.D.,  Milwaukee.  (Reprint  from  Trans. 
State  Med.  Society,  Wisconsin.) 

Annual  Address  delivered  before  the  American 
Academy  oj  Medicine  at  New  York,  20th  Sept., 
1881.  By  E.  T.  Caswell,  A.M.,  M.D.,  Presi- 
dent. Reform  in  Medical  Education  the  aim 
of  the  Academy. 


MttXmp  at  p^dial  ^mtX\t%, 


NORTH-WESTERN    BRANCH,    ON- 
TARIO MEDICAL  ASSOCIATION. 

The  following  were  present  : — Drs.  Nichol, 
Dingman,  and  Burgess,  of  Listowel  ;  Collinge, 
Stewart,  and  Standish,  of  Palmerston ;  Yeo- 
mans,  of  Mount  Forest;  Sinclair,  of  Walkerton  ; 
Gillies,  of  Chesley  ;  Gun,  of  Durham  ;  Cowan, 
of  Harriston  ;  Sloan,  of  Bl>th  ;  Graham,  oi 
Brussels  ;  and  Stewart,  of  Brucefield. 


Dr.  Yeomana  in  the  chair. 

It  wa.s  moved  hy  Dr.  Gun,  seconded  by  Dr. 
Sinclair,  "Thut  we  form  a  Medical  AsROcia- 
tion  to  be  known  as  the  North- Western 
Brunch  of  the  Ontario  Medical  Association." 
Carried. 

It  was  moved  by  Dr.  Gun,  seconded  by  Dr. 
Gillies,  "  That  the  meetings  be  held  quarterly." 
Cairied. 

Moved  by  Dr.  Gun,  seconded  by  Dr.  Sinclair, 
"  That  Dr.  Yeomans,  of  Mount  Forest,  be 
President  for  the  ensuing  year."     Carried. 

Moved  by  Dr.  Burgess,  seconded  by  Dr. 
Gun,  "That  Dr.  Stewart,  of  Brucefield,  be 
appointed  Secretary  for  the  ensuing  year." 
Carried. 

It  was  moved  by  1  r.  Gun,  seconded  by  Dr. 
Stewart,  of  Palmerston,  "  That  the  Constitu- 
tion and  By-laws  of  the  Ontario  Medical 
Association  be  adopted,  except  article  (7)  seven." 
Carried. 

It  was  decided  to  hold  the  next  meeting  at 
Palmerston,  on  the  i5th  of  February,  at  2  p.m. 

Drs.  Graham,  of  Brussels ;  Collinge,  of 
Palmerston ;  and  Stewart,  of  Bruce6eld,  were 
appointed  to  read  papers  at  the  February 
meeting. 

Dr.  Standish,  of  Palmerston,  was  appointed 
to  open  a  discussion  on  the  nature  and  treat- 
ment of  diphtheria. 

J.  Stewart,  Secretary. 


APPOINTMENTS. 

Robert  William  Bell,  of  the  town  of  Peter- 
borough, Esquire,  .W.D.,  to  be  an  associate 
coi'oner  in  and  for  the  County  of  Peterborough. 

William  Henry  Taylor,  of  the  village  of 
Bradford,  E  quire,  M.B.,  to  be  an  associate 
coroner  in  and  for  the  Countv  of  Simcoe. 


gtrtlt$,  parriageisi  and  JcatUsi. 


MARRIAGES. 

On  the  14th  inst.,  at  the  residence  of  Dr.  W.  W. 
Ogden,  170  Spadina  Avenue,  by  the  Rev.  W.  J.  Hunter, 
a.ssisted  by  Rev.  N.  R.  Willoughby,  Dr.  Geo.  Willcock, 
to  Annie,  eldest  daughter  of  William  Filbert. 

At  Ferry  land,  Newfoundland,  November  21st,  Robert 
Hillary  Carey,  M.D.,  late  ol  Halifa.x,  N.S  ,  to  Mary 
Le'Messurier Morry,  third  daughter  of  John  Morry, 
Esq.,  Postmaster  oV  Ferry  land. 

At  St.  Jude's  Churcli,  Oakville,  on  the  8th  inst., 
by  the  Rev.  J.  B.  Worrell,  M.A.,  rector,  Dr.  Ernest 
Arthur  Smith,  of  Ripley,  County  of  Bruce,  only  son  of 
J.  E.  Berkeley  Smith,  Esq.,  Bursar  of  the  University 
College,  at  Toronto,  to  Lilian,  eldest  daughter  of  James 
W.  McCraney,  Esq.,  of  Elm  Place,  near  Oakville. 

DE.\TH. 

At  Baltimore,  Md.,  on  the  3rd  inst.,  Elizabeth  H. 
Girvin,  wife  of  E.  D.  Ault,  M.D.,  of  Aultsville,  in  her 
27th  year. 


THE 


^ 


dlanabian  Mmxml  of  Mtbital  ^mtt 


A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


0.  OGDEN,  M.D., 

R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond 


learning Mitars.     I        f"  "v^^'S  \^-  *'-^-'  "•^•*^-'"  ^"«-  l^*^'-^-- 
., )  I         I.  H.  CAMERON,  M.B.,  ' 


SUBSCRIPTION,   $3    PER    ANNUm. 


gS"  All  literary  oommunioations  and  Exchanges  should  be  addressed  to  Dr.  CAMERON,  28  Gerrard  St.  Kast. 
i^  All  business  communications  and  remittances  should  be  addressed  to  Dr.  WRIGHT,  312  Jarvis  Street. 

TORONTO,  FEBRUARY,  1882. 


THE  CAUSES  OF  THE   PRESENT   EPI- 
DEMIC OF  TYPHOID  FEVER. 

Bead  by  Mr.  W.  H.  Montague,  at  the  Inaugural  Meeting  of  the 

"  Toronto  School  of  Medicine  Medical  bociety," 

January  14th,  1882. 

Mr.  President  and  Gentlemen, — As  you 
are  aware,  the  medical  world  has  never  been 
unanimously  agreed  upon  the  exciting  cause  of 
this  disease.  At  the  present  day  we  meet  with 
two  principal  theories  which  in  altogether 
diflferent  ways  account  for  its  rise  and  spread. 
The  first  of  these,  whose  most  illustrious  advo- 
cate is  Dr.  Murchison,  declares  the  source  of 
the  affection  to  be  a  poison  derived  from  the 
decomposition  of  either  organic  or  inorganic 
substances.  The  product  of  this  decomposition 
by  various  means  gaining  entrance  into  the 
body  of  its  victim,  and  there  performing  its 
characteristic  work.  In  defending  this,  which 
he  names  the  "  Pythogenic "  theory.  Dr. 
Murchison  refers  to  the  outbreak  of  the  dis- 
ease at  Westminster  School  in  1857.  In  that 
case  he  tells  us  that  the  disease  followed 
very  exactly  in  its  course  the  line  of  a  foul  and 
long  neglected  private  sewer  or  iilimense  cess- 
pool, in  which  fcecal  matters  had  been  for  years 
collecting  without  means  of  exit.  This  sewer 
communicated  directly  with  the  drains  of  all  of 
those  who  were  stricken  with  the  epidemic, 
and  from  this  fact  Dr.  Murchison  concludes 
that  the  cause  of  the  disease  is  the  poison  of 
ordinary  decomposition.  With  regard  to  this, 
however,  Dr.  Collie,  of  the  Homertou  Fever 
Hospital,  has  pointed  out  that  although  the 
contents  of  this  cess-pool  had  been  accumu- 
lating for  years  and  emitting  its  horrid  stench, 


yet  the  outbreak  did  not  occur  until  imme- 
diately after  several  minor  cess-pools  had  been 
opened  into  the  larger  one. 

Had  the  typhoid  appeared  comparatively 
early  in  the  history  of  this  cess-pool  and  con- 
tinued during  its  existence,  it  certainly  would 
be  admissible  as  evidence  of  the  probability  of 
ordinary  decomposition  being  able  to  produce 
the  disease.  I  might  refer  you  to  the  records 
of  numerous  instances  where  epidemics  are 
supposed  to  have  had  a  similar  origin.  Indeed 
I  do  not  doubt  that  we  ourselves  have  most  of 
us  seen  occasions  when,  to  say  the  least,  it  would 
be  very  convenient  to  adopt  this  view  of  the 
matter ;  but  let  us  understand  that  not  only  do 
such  instances  not  establish  the  correctness  of 
the  theory  but  that  positive  evidence  is  at 
hand  to  prove  that  from  the  very  worst  forms 
of  ordinary  decomposition  no  typhoid  has 
arisen.  Dr.  W.  Budd  records  a  most  remark- 
able case  of  sewage  decomposition  unattended 
by  any  outbreak  of  disease,  viz.,  that  of  the 
Thames,  in  1858  and  '59,  "  When,"  to  use  his 
own  words,  "  the  sewage  of  nearly  three  million 
of  people  had  been  allowed  to  seethe  and  fer- 
ment beneath  a  burning  summer  sun.  So 
horrid  was  the  stench  that  the  river  steamers 
lost  their  accustomed  traffic,  and  even  hurried 
travellers  passed  miles  around  rather  than  cross 
London  bridge,"  and  yet  with  all  this  the  city 
was  remarkably  healthy.  Another  argument, 
which  may  be  justly  urged  aginst  the  pytho- 
genic theory  of  the  disease,  is  the  fact  of  its 
exhibiting  no  choice  of  those  who  in  the 
meanest  and  lowest  walks  of  life  are  in  the 
midst  of  continued  tilth,  who  are  no  more  liable 
to  the  disease  (beyond  the  fact  of  want,  dissi- 
pation, and  consequent  low  vitality  renderiiig 


38 


CANADIAN  JOURNAL 


them  more  liable  to  the  occurrence  of  any  dis- 
ease) than  are  their  more  fortunate  brethren  in 
the  higher  walks  of  social  life. 

"We  are,  therefore,  I  think  impelled  to  the 
conclusion,  notwithstanding  the  opinions  of  the 
eminent  Dr.  Murchison  and  his  supporters,  that 
to  the  rise  of  typhoid  fever  something  more 
than  ordinary  decomposition  is  indispensable. 

I  need  hardly  say  that  the  theory  most 
commonly  received  now  is  that  which  was  first 
favorably  promulgated  by  Dr.  YonGietl,  on 
the  continent,  and  which  Dr.  Budd  has  so 
strongly  advocated  in  England,  and  which 
makes  the  fever-producing  principle  the  exist- 
ence of  a  specific  poison,  an  organized  germ, — 
a  contagium  vivum, — derived  from  a  previous 
case  of  the  disease  introduced  into  the  body 
multiplying  itself  indefinitely  in  its  new 
position,  producing  symptoms  of  an  exactly 
similar  or  slightly  modified  type  to  those  of  the 
primary  disease,  passing  from  the  patient's 
body  in  the  alvine  discharges  meeting  with 
destruction,  or  more  frequently  finding  a  recep- 
tion in  some  situation  favorable  to  a  continu- 
ance of  its  life  and  development.  It  is  an  un- 
mistakable fact,  that  there  are  numberless 
instances  upon  record  where  the  disease  has 
been  conveyed  from  the  sick  to  others  who 
were  not  under  any  of  the  unhealthy  condi- 
tions to  which  the  original  patient  might  have 
been  subjected  previous  to  his  illness,  and 
which,  therefore,  could  be  accounted  for  on  no 
other  hypothesis  than  the  existence  of  a  specific 
poison.  Dr.  Austin  Flint,  in  his  "  Practice  of 
Medicine,"  lays  particular  stress  upon  the 
North  Boston  epidemic,  as  proving  the  con 
tagious  nature  of  the  disease. 

A  traveller  is  ill.  He  stops  at  the  tavern  in 
North  Boston,  a  small  village  of  nine  families, 
a  few  miles  from  Buff"alo.  His  case  proves  to 
be  a  well  marked  one  of  typhoid  fever,  and  he 
dies  in  a  very  few  days.  Up  to  that  time  no 
traces  of  the  disease  had  ever  been  known  in 
the  village.  The  neighbours,  all  but  one,  who, 
being  at  variance  with  the  rest  of  the  village, 
remained  within  his  own  home,  visited  the 
sick  man,  and  used  the  water  from  the  tavern 
well,  a^id  it  is  a  remarkable  fact  that  all  the 
families  in  the  village  were  afflicted  subsequently 
save  Stearns,  who  had  had  no  communication 


with  the  others,  and  who  used  water  from  a 
well  of  his  own.  In  forty-three  of  a  popula- 
tion there  was  no  less  a  percentage  than  ten 
deaths. 

As  Dr.  Flint  concludes,  the  laws  of  proba- 
bilities would  not  authorize  the  supposition 
that  the  peculiarity  of  the  events  depended 
upon  a  strange  coincidence,  and  nothing  more. 
Trousseau  nurrates  the  cifcuinstaiic^s  of  a 
number  of  outbreaks  in  different  parts  of 
France,  which  are  not  less  strong  proof  of  the 
existence  of  a  contagium  thau  that  to  which  Dr. 
Flint  gives  prominence.  Liebermeister,  in  his 
exhaustive  article  in  Ziemssen's  "  Cyclopaedia 
of  Medicine,"  defines  typhoid  to  be  a  miasmatic 
contagious  disease,  and  after  a  lengthened  dis- 
cussion of  the  matter,  concludes  decidedly  the 
poison  of  typhoid  fever  does  not  originate  in 
decomposing  substances  but  is  a  specific  poison 
of  itself ;  and  in  dealing  with  some  of  the 
objections  made  against  the  theory,  he  refers  to 
some  German  village  where  decomposition,  to 
no  small  extent,  had  been  going  on  for  ages,  and 
yet  no  typhoid  had  occurred  until  the  introduc- 
tion of  the  specific  poison.  Nor  do  I  think 
that  any  of  us,  even  though  our  fields  of 
opportunities  have  been  of  the  most  limited 
area,  are  unable  to  recall  instanctj.s  where 
the  rise  of  the  disease  was  explainable  on  no 
other  gBOund  than  that  which  Liebermister 
defends.  Accepting  then,  as  I  think  we  must, 
that  every  case  of  typhoid  has  its  origin  in  the 
poison  from  a  previous  case,  there  remains  but  a 
moment  for  us  to  consider  the  nature  of  that  con- 
tagium, after  which  we  shall  be  in  a  position  to 
discuss  particularly  the  epidemic  so  prevalent 
in  this  city. 

That  contagion  is  a  living  entity,  I  suppose 
is  accepted  as  proven  by  the  manner  in  which 
it  conducts  itself  both  outside  and  inside  the 
persons  of  its  victims.  That  it  is  discharged 
with  the  matters  from  the  bowels,  I'hw  will 
doubt,  whilst  some  have  contended  that  it  is  also 
discharged  with  the  other  excretions  of  the 
patient,  an  idea  that  seems  to  be  open  to  very 
serious  doubt. 

That  it  multiplies  itself  has  been  clearly 
proven,  a  fact  which  as  we  shall  see  hereafter, 
is  of  great  importance,  and  that  finding  its  way 
into  favourable  situations,  its  existence  may  be 


OJP  MEDICAL  SClENCk 


dd 


much  prolonged,  and  that  it  remains  suspended 
in  fluids  or  mingled  with  atmospheric  air,  in 
both  of  which  situations  it  retains  its  inherent 
activity. 

From  what  we  have  seen  then,  of  the  nature 
of  this  contagion,  we  can  readily  understand  how 
a  single  case  of  the  disease,  under  circumstances 
favorable  to  the  spread  of  the  poison,  might  be 
justly  regarded  as  the  starting  point  of  even  a 
more  severe  epidemic  than  that  it  has  been 
the  misfortune  of  Toronto  to  have  felt  during 
the  past  summer  and  autumn.  Nor  do  I  think 
it  an  extravagant  supposition  that,  in  a  city 
of  nearly  a  hundred  thousand  inhabitants, 
there  should  always  exist  one  or  more  cases  of  a 
disease  peculiar  to  the  country.  Dr.  Wilson, 
indeed,  in  his  work  on  the  Specific  Febrile 
Diseases,  declares  that  no  city  of  the  temperate 
zones  is  ever  free  from  the  disease.  But  it 
is  not  even  necessary  to  suppose  a  single  case 
actually  in  existence  at  the  time  of  the  out- 
break of  an  epidemic.  From  what  I  have  said 
regai'ding  the  contagium,  we  can  readily 
conceive  of  an  outbreak  finding  its  origin 
in  poison,  which,  arising  from  a  case  long 
past,  has  been  disturbed  and  found  its  way  into 
channels,  through  which  it  infects.  In  adopt- 
ing this  idea  of  a  contagium,  and  rejecting  the 
"filth  and  dirt"  theory,  I  do  not  wish  to  be 
understood  as  desiring  to  detract  from  the  glory 
of  those  to  whose  tender  mercies  the  sanitary 
matters  of  our  city  are  committed.  Were  it 
possible  typhoid  fever  could  arise,  as  Dr.  Mur- 
chison  contends  it  does  from  "  filth  and  dirt," 
be  it  said  to  the  credit  of  those  particularly 
interested  this  would  have  been  a  potent  factor 
in  bringing  about  the  epidemic  we  discuss  to- 
night. 

Supposing,  then,  one  or  more  cases  of  the 
disease  have  existed  in  Toronto  at  some  pre- 
vious time,  I  wish  to  point  out  a  number  of 
circumstances  which  have  assisted  greatly  in 
rendering  the  disease  sufficiently  prevalent  as 
to  be  justly  entitled  an  epidemic. 

The  summer  and  autumn  just  past  have  been 
seasons  of  unusual  drouth,  and  more  than  once 
has  it  been  pointed  out  that  drouth  and  heat 
are  favorable  to  the  spread  of  the  malady. 

In  England  the  summers  of  1866,  1866, 
1868,  and    1870,    were   remarkable  alike   for 


their  great  heat  and  prolonged  drouth,  the 
early  rise  and  rapid  and  extensive  spread  of 
enteric  fever.  Whilst  the  summer  of  1860 
was  noted  for  its  cold  and  wet,  and  likewise 
for  its  unusual  freedom  from  the  disease.  In- 
deed the  records  of  the  London  Hospital  show 
that  in  the  year  just  mentioned,  typhoid  patients 
were  only  50  per  cent,  as  numerous  as  the 
average  for  the  twelve  years  previous.  It 
might  be  as  well  to  notice  in  passing  that  the 
City  Commissioner  is  not  in  any  way  responsible 
for  any  influence  which  the  drouth  of  the  past 
summer  may  have  had  over  the  epidemic. 

Drs.  Bristowe  and  Collie  difier  as  to  when 
the  discharges  from  the  sick  are  capable  of 
infecting.  The  former  says  "  not  until  decom- 
position has  set  in."  I  am  inclined  to  think 
with  the  latter,  that  fresh  stools  are  capable 
of  infecting ;  and  should  we  accept  Dr.  Collie's 
opinion  upon  this  point,  we  have  at  once  an 
important  means  by  which  the  disease  may 
spread.  Attendants,  members  of  the  same 
family,  and.  visitors  are  liable  to  be  the  agents 
by  which  typhoid  may  be  carried  to  other  parts. 
However  this  may  be,  I  do  not  doubt  that  this 
epidemic,  as  all  other  epidemics  of  the  same 
kind,  has  been  mostly  caused  by  the  careless 
and  improper  disposal  of  the  discharges  from 
the  bowels  of  the  sick.  These  discharges  not 
receiving  proper  disinfection,  and  being  thought- 
lessly disposed  of,  the  germ  is  allowed  to  live, 
and  ultimately  finds  itself  a  way  into  sources 
whence  it  contaminates  all  of  the  population. 
In  the  first  place  it  may  do  this  through  the 
medium  of  the  atmosphere.  I  believe  there 
can  be  no  doubt  that  these  germs  may  float 
about  in  the  air,  gain  entrance  to  the  mouth 
in  the  inspirations,  and  afterwards  become 
swallowed.  Some  one  has  suggested  that  they 
even  enter  the  lungs  and  there  mingle  directly 
with  the  blood. 

Liebermeister  states,  that  in  the  hospital  at 
Basle,  he  often  saw  cases  aiise,  which  as  far  as 
could  possibly  be  seen,  excluded  every  other 
means  tban  propagation  by  the  atmosphere ; 
and  Dr.  Von.  Gietl  cites  a  very  interesting 
case  of  the  village  girl,  who  had  contracted 
typhoid  fever  in  Ulms,  and  returned  to  her 
native  village,  where  typhoid  fever  had  not 
been  known  lor  a  long  period  of  time,  to  remain 


40 


CANADIAN  JOURNAL 


during  her  illness.  The  discharges  from  the 
bowels  were  thrown  upon  a  dunghill.  Several 
weeks  later,  five  persons  were  employed  in  re- 
moving the  dunghill,  when  four  became  stricken 
with  the  disease.  The  excrement  of  these  four 
patients  being  buried  deep  in  the  dunghill. 
Nine  months  later,  two  persons  were  employed 
in  completely  removing  the  dunghill,  when  one 
of  them  sickened  with  typhoid  and  died. 
Granting,  then,  that  air  is  capable  of  being  in- 
strumental in  this  way,  there  can  be  little 
difficulty,  I  think,  in  seeing  how  it  has  assisted 
in  spreading  the  present  epidemic.  In  many 
cases,  no  doubt,  the  fceces  have  been  thrown 
upon  yards,  or  neighboux-ing  vacant  lots,  or 
into  out  privies  used  by  a  number  of  people, 
and  have  filled  the  air  with  the  typhoid  pro- 
duct. In  other  cases  these  foeces  have  been  cast 
into  privies  connected  with  the  sewers,  and  the 
contents  of  the  sewers  have  by  this  and  other 
means  been  made  bearers  of  the  germ,  which 
has  escaped  from  them  together  with  other 
matters  (not  necessarily  gaseous)  on  account  of 
defective  traps,  badly  constructed  privy  vaults, 
local  stoppages  of  the  drain,  and  other  means. 

But  unfortunately  air  is  not  the  only  medium 
through  which  the  disease  has  in  all  likelihood 
spread. 

Very  many  instances  are  upon  record  where 
contaminated  drinking  water  has  been  a  fruit- 
ful cause.  Stuttgart  was  afflicted  with  an 
epidemic  in  1872.  In  1881,  the  meadows  from 
which  a  portion  of  Stuttgart  aqueduct  is  sup- 
plied, had  been  thickly  manured  with  matters 
taken  from  the  city  sewers.  In  January,  1872, 
a  thaw  occurred,  and  on  February  following 
typhoid  became  prevalent  in  that  portion  of 
the  city  supplied  by  this  means,  although  in 
other  parts  the  disease  was  no  more  prevalent 
than  at  ordinary  times. 

The  epidemic,  too,  which  occurred  in  the 
valley  village  of  Lausanne,  Switzerland,  in  the 
same  year,  and  in  which  one  hundred  and  forty 
persons  were  attacked,  is  even  better  evidence 
on  this  point. 

A  mountain  stood  beside  this  village,  and 
beyond  the  mountain  a  valley,  in  which  a  few 
farm  houses  were  situated.  From  the  foot  of 
the  mountain  Lausanne  received  its  water  sup- 
ply.    A  case  of  typhoid  occurred  in  the  valley 


beyond.  The  dejections  were  thrown  into  a 
small  stream,  and  immediately  upon  the 
meadows  of  the  valley  being  irrigated  for  a 
second  hay  crop,  an  epidemic  occurred  in 
Lausanne,  which  had  always  been  peculiarly 
healthy  and  free  from  disease.  It  was  be- 
lieved that  water  from  beyond  the  mountain 
could  find  its  way  into  the  spring  whence 
Lausanne  received  its  water  supply. 

This  was  established  by  salt  being  put  into 
the  stream  beyond  the  mountain,  salt  appearing 
on  the  day  following  in  the  Lausanne  stream. 
Thus  the  poisoned  water  from  the  neighbouring 
valley  had  found  its  way  by  a  long  underground 
course  into  the  spring  at  the  base  of  the  moun- 
tain, and  had  borne  disease  and  death  into  the 
homes  of  Lausanne.  I  need  say  nothing  regard- 
ing city  water.  The  source  of  supply  has  been 
condemned  by  competent  authority.  But  well 
water  is  even  worse  than  city  water.  Numer- 
ous families  are  supplied  by  wells,  whose  con- 
tents are  rendered  anything  but  pure  by  the 
soakage  which  they  receive  from  yard  and 
privy,  the  latter  convenience  being  in  many 
cases  their  nearest  neighbour. 

Again,  a  great  deal  of  milk  is  consumed  in 
Toronto,  or  rather  a  small  amount  of  milk 
mingled  with  a  very  large  proportion  of  water. 
It  has  been  shown  that  only  a  very  small  per- 
centage of  the  vendors  deal  out  unadulterated 
milk,  and  the  fact  of  their  watering  the  article 
is  in  itself  enough  to  make  us  sincerely  doubtful 
whether  they  are  scrupulously  careful  regarding 
the  quality  of  the  water  which  they  employ. 
Indeed,  the  appearance  of  man  and  outfit  in 
many  cases  would  lead  us  to  suspect  that  the 
water  thus  used  had  been  intended  for,  and 
certainly  badly  needed,  in  a  cause  more  respect- 
able but  decidedly  less  profitable. 

After  all,  however,  it  is  perhaps  as  well  that 
the  individual  does  not  employ  that  amount  of 
ablution  which  we  would  deem  necessary,  as 
in  any  case  he  would  not  be  likely  to  be  dis- 
posed to  waste  the  water. 

In  Southport,  one  case  after  another  was 
occurring,  until  in  two  weeks  a  total  of  28  was 
reached.  The  health  officer  found,  to  his  sur- 
prise, that  with  two  trifling  exceptions  the 
sanitary  condition  of  the  houses  was  excellent. 
At  last  it  was  discovered  that  all  the  families 


O^  MEDICAL  SCIENCE. 


41 


afflicted  were  supplied  with  milk  by  a  certain 
dairyman,  A  visit  to  this  dairyman's  premises 
led  to  the  discovery  of  a  well  horribly  polluted 
with  soakage  from  a  filthy  cesspit  near  it.  This 
milk  supply  was  stopped,  and  the  epidemic  ceased 
to  spread, 

I  do  not  doubt  that  similar  causes  have 
operated  here  ;  but  the  successful  means  which 
Southport  adopted  to  search  them  out  are 
seemingly  not  at  hand,  and  they  probably 
operate  still,  in  not  only  assisting  typhoid  to 
spread,  but  in  being  the  direct  cause  of  many 
of  those  disorders  to  which  the  infantile  portion 
of  our  population  is  especially  liable. 

Those  who  believe  that  animals  are  subject 
to  typhoid,  of  course  point  to  unwholesome 
meat  being  a  means  by  which  the  affection  may 
spread,  I  do  not  think  that  we  would  be 
justified  in  supposing  this  to  have  had  an  in- 
fluence in  the  present  case. 


HOSPITAL  NOTES. 


BY  L.  M.  SWEETNAM,  M.D.,  CM. 

The  following  are  notes  on  cases  at  present 
in  the  General  Hospital,  under  the  care  of  Dr. 
I.  H.  Cameron ;  the  treatment  mentioned  was 
adopted  at  his  request, 

Ammoniacal  Inhalations. — It  is  an  old  idea 
that  the  atmosphere  of  stables  and  cow-houses, 
which  contains  the  carbonate  of  ammonia  in 
considerable  quantity,  is  beneficial  to  those 
suffering  from  pulmonary  phthisis.  Recently 
Melsens  conceived  the  idea  that  the  moderate, 
but  continuous  inhalation  of  this  salt  might  be 
useful  in  many  affections  of  the  respiratory 
organs.  In  order  to  prove  the  value  of  this 
form  of  treatment,  he  caused  several  patients, 
suffering  from  bronchitis,  to  wear  outside  their 
shirts,  and  over  the  upper  part  of  the  sternum, 
a  bag  containing  some  pieces  of  carbonate  of 
ammonia,  the  almost  invariable  result  was  re- 
lief from  the  first  day  of  wearing  it.  He  also 
successfully  tested  the  remedy  in  his  own  per- 
son, when  suffering  from  bronchitis,  as  did  also 
a  Belgian  physician  in  Brussels. 

This  treatment  we  adopted  a  few  weeks  ago 
in  the  case  of  two  patients  tormented  with  a 
distressing  cough,  one  due  to  tubercular,  the 
other  to  simple  chronic  bronchitis.    During  the 


first  night  one  of  the  patients  complained  of  a 
sense  of  suffocation,  and  fullness  of  the  head;  on 
the  day  following,  however,  the  cough  appeared 
less  troublesome  in  both  cases,  and  at  the  end 
of  ten  days  their  sleep,  which  had  previously 
been  much  broken  by  the  cough,  became  com- 
paratively undisturbed ;  the  feeling  of  lassitude 
consequent  upon  the  broken  rest  to  a  great  ex- 
tent disappeared,  the  expectoration  became 
diminished  in  quantity,  and  instead  of  being 
greenish  in  colour,  became  almost  white,  and 
frothy  in  one,  and  disappeared  in  the  other. 

In  ten  or  twelve  days,  the  carbonate  of  am- 
monia— about  5  iv. — had  become  entirely  vol- 
atilized, the  bags  were  not  then  refilled,  and 
before  a  week  had  elapsed  both  patients  were 
anxious  to  resume  the  treatment,  one  on  ac- 
count of  a  nasal  catarrh,  which  had  been  much 
relieved  by  the  ammonia,  and  both  for  the  re- 
lief of  the  cough,  which  had  increased  while 
the  treatment  was  omitted.  The  ammoniacal 
inhalation  has  since  been  resumed  with  the 
usual  improvement. 

We  are  inclined  to  believe  that  in  this  form 
of  inhalation,  we  have  a  remedy  calculated  to 
palliate — in  the  majority  of  cases — that  most 
distressing  symptom  of  a  disease  so  constantly 
fatal,  and  over  whose  course  we  have  so  little 
control. 

Whilst  special  attention  has  been  pMd  to  its 
usefulness  in  the  treatment  of  cough,  due  to 
tubercular  bronchitis,  we  expect  to  hear  of  its 
success  in  the  treatment  of  coughs  due  to 
chronic  bronchitis,  even  when  complicated  by 
dilatation  of  the  bronchi ;  it  may  also  prove 
useful  in  the  treatment  of  acute  laryngitis,  as 
narrated  of  a  case  in  the  London  Medical 
Record. 

Alcoholism,  and  Pneumonia. — There  appears 
to  be  a  pretty  widespread  opinion  that  pneu- 
monia in  an  alcoholic  patient  is  a  disease  ne- 
cessarily attended  with  a  fafal  result.  This 
impression  is,  no  doubt,  true  in  the  main ;  but 
the  following  is  a  brief  history  of  a  case  which 
had  a  more  fortunate  termination,  probably  due 
to  the  patient's  youth  : — 

W.  W,,  aged  20,  was  admitted  into  the 
Hospital  on  Thursday  night,  the  29  th  December. 
As  ascertained  from  himself,  after  convales- 
cence, he  had  been  given  to  drinking  for  three 


42 


CANADIAN  JOUKNAL 


or  four  yeai-s,  but  heavily  only  at  intervals 
during  the  past  year.  He  was  a  tuck-pointer 
by  trade,  and  lately  much  exix»sed  to  wet  and 
damp.  On  the  Saturday  preceding  his  ad- 
mission he  had  been  on  a  heavy  spree,  and  on 
Sunday  felt  greatly  out  of  sorts.  He  soon  de- 
veloped pain  in  the  right  side  and  cough,  and 
on  medical  advice  being  sought  it  was  ascer- 
tained, he  said,  that  he  was  threatened  with 
inflammation  of  the  right  lung,  which,  however, 
the  doctor  hoped  to  avert.  Instead  of  improv. 
ing,  however,  he  grew  worse,  and  on  Thursday 
he  was  so  delirious  and  unruly  that  hia  mother 
had  him  removed  to  the  Hospital.  He  was 
admitted  in  a  semi-conscious  state  with  pain  in 
right  side  and  difiiculty  in  breathing.  During 
the  night  active  delirium  t7'eme7is  developed  • 
he  talked  incessantly  in  a  rambling  fashion, 
sufiered  from  hallucinations  of  sight,  and  could 
with  difiiculty  be  kept  in  bed.  Examination 
of  the  chest  on  the  following  day  revealed  the 
physical  signs  of  pneumonia  (crepitation  in  some 
parts,  tubular  breathing,  dullness,  and  increased 
vocal  fremitus),  over  the  greater  part  of  the 
right  lung ;  the  expectoration  resembled  a  thick 
bloody  jelly  and  was  copious.  He  was 
ordered  : — Amnion,  carb.  5^1^^- >  ^^-  cinchon. 
CO.  3j',  tr.  capsici,  '^ij.,  syrupi,  tj.,  aquae  ad. 
Jviij.  Sig.  ^ss.  o.  h.  3.  sum.  The  pulse  was 
small,  soft,  and  feeble,  and  the  skin  perspiiing. 
He  was  allowed  milk  ad  libitum,  but  no  stimu- 
lants. On  admission  he  had  been  given  halt 
drachm  doses  of  bromide  oi  potash  and  chloral 
hydrate  ;  but  notwithstanding  their  repetition 
at  a  few  hours'  interval,  he  got  no  sleep  for  the 
first  two  or  three  days,  and  then  only  moment- 
ary snatches,  waking  up  as  delirious  as  ever,  so 
that  he  had  to  be  constantly  watched  for  five 
or  six  days  and  nights,  but  ultimately  fell 
asleep  and  woke  up  rational.  The  lung  symp- 
toms remained  in  statu  quo  for  several  days, 
except  that  the  sputa  assumed  the  prune  juice 
type,  and  resolution  then  set  iu  and  pi'Ogressed 
with  fair  rapidity.  An  attack  of  diarrhoea 
came  on  which  proved  rebellious  to  the  ward 
mixture  (catechu,  paregoric,  and  lime  water) 
for  a  couple  of  days,  but  was  soon  controlled  by 
the  following : — R.  Argenti  nitratis  gr.  xvj.  ; 
acidi  uitrici  diluti,  5iiJ.  ;  tincturse  opii  deo- 
doratee,  ^ij  ;    tinctures  cardamomi  compositse. 


3  j  ;  mucilaginis  acacise  ad,  Jviij  ;  misce.  Sig  : 
38S.,  exaqua  o.  h.  4.  sumat.  Convalescence  was 
speedily  established  and  he  went  out  on  Janu- 
ary 18th  cured. 


PUERPERAL  ECLAMPSIA. 

BY  JOHK  FERGUSON,  B.A.,  M.B.,   L.R.C.P,  EDIN. 

Assistant  Demonstrator  of  Anatomy,  Toronto  School  of  Medicine. 

Recently  this  subject  has  been  attracting  a 
good  deal  of  attention  in  the  columns  of  the 
Canadian  Journal  of  Medical  Science. 
The  variety  of  treatment,  which  has  been  pro- 
posed from  time  to  time,  is  sufficient  proof  of 
the  importance  of  the  disease.  In  this  article 
I  purpose  making  a  few  remarks  that  may  lead 
others  to  give  the  results  of  their  observations 
and  experiments  in  its  management.  I  wish 
to  say  in  the  beginning  that  my  opinion  is  that 
eclampsia  may  be  due  to  difierent  causes ;  but 
the  great  factor  is  the  reflex  excitability  of  the 
nervous  system,  found  at  or  about  the  time  of 
confinement. 

1.  Cases  may  arise  from  congestion  or  hyper- 
asmia  of  the  nerve  centres.  These  occur 
generally  in  plethoric  persons  of  short  stature, 
and  thick  neck.  During  labor  the  lungs  are 
filled  with  air,  the  diaphragm  fixed,  the  glottis 
closed,  and  violent  efibrts  made  to  effect  the 
expulsion  of  the  uterine  contents.  There  is 
powerful  muscular  action  during  a  long  interval 
that  the  same  air  is  retained  in  the  lungs.  In 
other  words  violent  expiratory  efforts  without 
expiration  being  accomplished.  These  are  just 
the  circumstauces  that  favour  cerebral  conges- 
tion, and  especially  when  they  occur  iu  persons 
such  as  we  have  supposed.  In  this  condition  the 
blood  becomes  highly  venous  and  loaded  with 
oarbou  dioxide.  Now  it  is  well  known  that 
carbon  dioxide  in  the  blood  acts  as  a  powerful 
stimulant  to  the  respiratory  centres,  and  causes 
convulsive  efforts  to  breathe.  Here  we  have  a 
cause,  which  acting  at  this  irritable  period  of 
the  nerve  system,  is  sufficient  to  diffuse  itself 
over  wide  areas  of  the  motor  tracts.  Should 
eclampsia  take  place  in  such  a  patient,  I  would 
certainly  advocate  the  use  of  the  lancet,  and 
then  give  morphia  hypodermically  to  calm  the 
system  and  lower  reflex  excitability,  which  it 


OF  MEDICAL  SCIENCE. 


4S 


beyond   all    doubt    does.     Moderate    doses    of 
morphia  are  quite  sufficient  in  such  cases. 

2.  Cases  of  the  second  class  arise  from  some 
poison  in  the  blood.  They  are  toxaeraic.  What 
the  true  nature  of  this  poison  is  we  do, not 
know  ;  but  it  acts  as  an  irritant,  and  causes 
spasmodic  action  of  the  muscular  system,  as  is 
seen  in  anaemia.  Here  morphia  is  likely  to 
achieve  its  greatest  conquests.  It  will  most 
assuredly  blui»t  the  nerve  centres  and  lessen  the 
reflex  action  of  both  cord  and  brain.  In  such 
cases,  it  must  be  pushed  with  no  timid  hand, 
and  given  in  at  least  gr.  i.  to  gr.  iss.  doses 
hypodermically,  and  followed,  if  required  by 
sufficient  -njections  to  keep  the  nervous  system 
quiet.  It  should  be  followed  with  diuretics 
and  purgatives.  Examples  of  this  kind  may 
occur  from  an  early  date  in  gestation  onward 

3.  The  third  class  of  cases  to  be  noticed^is 
the  anaemic.  I  am  inclined  to  regard  these  as 
by  far  the  most  frequent.  The  anaemic  state 
of  the  nerve  centres  may  exist  in  many  persons 
who  escape  convulsions,  owing  to  a  less  excit- 
able state  of  the  nervous  system  or  the  anaemia 
not  being  so  marked.  The  impoverished  and 
hydraemic  state  of  the  blood  has  existed  for 
some  time  previous  to  labor.  The  nerve 
centres  have,  for  some  time,  been  poorl}^ 
nourished,  and  have  become  irritable,  in  facfc 
they  are  in  a  fit  condition  for  reflex  action. 
When  great  muscular  efforts  are  being  made, 
large  amounts  of  oxygen  are  demanded,  but 
this  latter  is  just  what  the  watery  blood  and 
enfeebled  circulation  cannot  give.  We  have 
seen  that  carbon  dioxide  is  a  powerful  excitant 
to  muscular  action  when  it  comes  in  contact 
with  the  nerve  centres.  Just  so  is  the  want  of 
oxygen.  This  lack  of  oxygen  in  an  excitable 
state  is  a  sufficient  cause  for  severe  convulsive 
efforts.  What  will  morphia  do  in  such  a  case  1 
If  given  in  suitable  quantities,  say  gr.  ss.  hypo- 
dermically, it  acts  as  a  tonic  to  the  heart's 
action,  the  beats  become  slower,  fuller,  and 
steadier.  But  this  is  not  all.  It  greatly 
increases  arterial  tension,  and  thtis  improves 
the  circulation  through  the  nerve  centres,  and 
gives  them  more-oxygen.  At  the  same  time 
it  lessens  the  reflex  irritability  of  the  cord  and 
brain  as  we  have  already  seen.  The  hypo- 
dermic injection  of  digitalis  has  already  yielded 


good  results,  and  may  be  combined  with  the 
morphia.  When  thus  administered  it  acts 
speedily  as  a  heart  tonic. 

4.  A  fourth  set  of  cases  arises  from  irritation 
in  the  digestive  system.  After  a  full  meal  of 
rich  articles  of  diet,  the  woman  has  a  convul- 
sion. Here  the  pneumo-gnstric  and  sympathetic 
nerves  carry  information  of  the  state  of  matters 
to  the  centres,  and  there  follows  convulsive 
action  of  a  reflex  character.  In  such  a  case  an 
emetic,  enough  morphia  (o  soothe  and  a  purga- 
tive are  all  that  are  required. 

5.  In  a  fifth  class  of  cases  the  uterine  system 
is  the  cause.  Here  the  trouble  is  purely  reflex. 
The  sympathetic  and  sensory  filaments  of  the 
cerebro-spinal  nerves  carry  the  stimulus  to  the 
centres,  and  there  is  reflected  along  the  motor 
nerves  to  spend  itself  in  a  convulsion.  Morphia 
is  again  useful  on  f-cientific  grounds  ;  for  by  it 
we  have  complete  control  over  such  cases.  It  is 
in  this  group  that  we  mainly  meet  with  true 
eclampsia  at  a  very  early  period  of  pregnancy. 


KARE  DISLOCATION  OF  THE  UPPER 
EXTREMITY  OF  ULNA  INWARDS, 
THE  RADIUS  REMAINING  IN  ITS 
NORMAL  POSITION. 

BY    GEORGE    WBIGHT,    M.A.,  M.B., 

Demonstrator  of  Anatomy,  and  Associate  Lecturer  in  Materia 

Medica,  Toronto  School  of  Medicine.    Surgeon  to  the 

Hospital  for  Sick  Children  and  Home  for 

Incurables. 

Miss  A.  B.,  aet.  9,  met  with  the  accident  on 
Tuesday,  August  24th,  1881.  Supposed  to 
have  fallen  about  three  feet  on  the  elbow.  Saw 
her  at  ray  office  the  following  morning. 
Diagnosed  dislocation  of  uppor  extremity  of 
ulna  inwards,  and  attempted  to  reduce  it,  but 
without  success.  On  same  afternoon  was  seen 
at  Hospital  for  Sick  Children,  by  Drs.  A.  H. 
Wright  and  Machell,  in  conjuction  with  myself. 
As  some  doubt  was  expressed  about  the  cor- 
rectness of  my  diagnosis,  I  decided  to  keep 
limb  quiet  a  few  days,  and  on  leaving  the  city 
for  ten  days  the  case  was  under  the  charge  of 
Dr.  A.  H.  Wright.  During  this  time  Dr. 
Cameron  also  saw  the  case.  As  soon  as  the 
swelling  subsided  it  was  evident  that  thei'o  was 
a  dislocation,  and  I  directed  the  friends,  on  my 
return,  to  bring  the  child  again  to  the  hospital ; 


44 


CANADIAN  JOURNAL 


but  a  delay  ensued  on  account  of  the  objections 
of  the  mother  to  have  "anything  done"  to 
hurt  the  girl.  At  length,  after  urgent  solicita- 
tions on  my  part,  they  brought  her  to  the  hospital 
on  the  21st  September,  twenty -eight  days  after 
the  accident.  A  careful  examination  was  made 
by  almost  all  the  membera  of  the  staff,  and  accu- 
rate measurements  between  the  boney  promin- 
ences were  taken,  and  all  agreed  that  there 
was  dislocation  inwards  of  the  olecranon  process 
upon  the  inner  condyle  of  the  humerus,  the 
head  of  the  radius  remaining  in  its  normal 
position.  There  was  no  pain  nor  swelling ;  all 
the  motions  of  the  arm  were  perfect ;  but  the 
patient  was  unable  to  sustain  any  weight  upon 
the  arm  in  extension  by  reason  of  the  tendency 
to  rotate  inwards,  and  the  "  carrying  power" 
was  lost.  I  attempted  reduction  under  anaes- 
thetics, but  after  an  hour  and  a  half's  effort  by 
myself  and  all  the  gentlemen  present,  and  by 
every  means  suggested  by  the  best  authorities, 
we  failed  to  reduce  the  dislocation.  The  arm 
was  put  in  an  elevated  easy  position,  with 
patient  in  bed,  cold  water  applied,  and  not  a 
single  bad  symptom  followed  this  somewhat 
violent  manipulation.  The  friends  refused  to 
allow  any  further  attempts  at  reduction. 

I  have  given  this  brief  report,  in  the  first 
place,  on  account  of  the  great  rarity  of  the  acci- 
dent. I  can  find  no  report  of  a  case  exactly 
like  it.  Dr.  Frank  Hamilton  simply  mentions 
the  possibility  of  such  a  dislocation.  In  the 
second  place,  the  fact  that  we  were  utterly 
unable  to  reduce  the  dislocation  after  such  a 
prolonged  trial  was  to  me  a  matter  of  great 
surpiise  as  well  as  disappointment,  because  the 
joint  was  exceedingly  lax  and  the  olecranon  was 
freely  movable,  the  tip  gliding  very  readily  up 
and  down  the  posterior  surface  of  the  internal 
condyle.  In  fact,  from  all  the  indications,  I  ex- 
pected it  would  be  a  comparatively  easy  matter 
to  place  the  bone  in  its  proper  position.  The 
laxity  alluded  to  was  not,  however,  confined  to 
the  elbow,  but  existed  in  all  her  joints,  and 
the  fingers  especially  were  all  "  double-jointed." 
When  the  child  was  two  years  of  age  she  re- 
ceived an  injury  to  this  same  elbow  which 
caused  the  separation  of  this  epiphysis,  the  ex- 
ternal condyle  being  broken  off,  and  it  may  be 
that  this  accident  left  a  condition  in  the  joint 
which  favoured  the  possibility  of  the  inward  dis- 
placement of  the  upper  extremity  of  the  ulna 
without  carrying  the  radius  with  it. 


A   RARE  CASE  OF  CALCULUS. 

UNDER  THE  CARE  OF  L,  m'fARLANE,  M.B., 

Surgeon  to  the  Toronto  Qenaral  Hospital  and  to  the  Home  lor 
Ineurableo.    Adjunct  to  the  Chair  of  Anatomy,  and  De- 
monstrator in  the  Toronto  School  of  Medicine. 

For  the  notes  of  this  interesting  case  we  are 
indebted  to  Mr.  W.  H.  Macdonald  of  the  Resi- 
dent Staff. 

W.  B.,  aged  19,  was  admitted  into  the 
Hospital,  from  the  Home  of  Incurables  where 
he  had  been  two  weeks,  on  —  Dec,  1881. 
He  was  very  low,  and  no  history  was  obtain- 
able, except  that  he  had  been  suffering  for  6  or 
7  years.  He  was  very  much  emaciated  and 
ill-developed,  and  presented  the  appearance  of 
a  boy  10  or  12  years  old.  A  hard,  brawny, 
red  and  tumid  condition  of  the  perineum  was 
found ;  and  a  little  to  the  left  of  the  median 
line,  about  an  inch  in  front  of  the  anus,  a  small 
urinary  fistula  was  seen  to  open.  Catheterism 
was  impracticable.  An  incision  was  made 
through  the  centre  of  the  swelling,  and  the 
knife  struck  upon  a  stone.  On  introducing 
the  finger,  it  was  found  that  a  large  calcareous 
mass  occupied  the  whole  space  between  the 
pubic  arch  and  rectum.  In  view  of  its  size 
and  the  low  condition  of  the  patient,  no  at- 
tempt was  then  made  to  remove  it.  Per 
rectum  a  stony  mass  within  the  bladder  could 
be  detected.  Urine  dribbled  away  freely 
enough,  and  no  ursemic  nervous  symptoms  were 
presented ;  but  the  boy  shortly  succumbed  to 
an  incoercible  diarrhoea  and  asthenia. 

The  autopsy,  made  a  few  hours  after  death, 
revealed :  thoracic  organs,  normal  ;  liver, 
slightly  enlarged  and  fatty.  The  left  kidney 
was  represented  by  a  small  mass  of  fat  and 
fibrous  connective  tissue,  reniform  in  outline, 
but  devoid  of  kidney  structure,  with  a 
shrunken  and  impervious  ureter.  The  right 
kidney  was  a  large,  purulent  sac,  with  very 
little  renal  structure  remaining.  Its  ureter  was 
dilated.  The  bladder  was  thickened  and  con- 
tracted, closely  enveloping  a  phosphatic  calculus, 
one-half  ounce  in  weight.  The  lower  bladder 
wall  was  defective,  so  that  the  calculus  it  con- 
tained articulated  by  a  facetted  surface  with 
the  extra-vesical  calcareous  mass  which  occupied 
all  the  space  beneath  the  arch  of  the  pubes, 
measuring  2  by  2^  by  1^  inches,  and  weighing 


OF  MEDICAL  SCIENCE. 


45 


2|  ounces.  The  urethra  seemed  to  be  obliter- 
ated at  its  pubic  end,  as  nothing  could  be  passed 
along  it,  and  no  connection  traced  between  it 
and  the  bladder.  The  spleen,  stomach,  and 
intestines,  appeared  normal. 


CASE  OF  EMPYEMA. 

(Under  the  care  of  Dr.  L.  McFarlane,  reported  by 
Mr.  "VV.  H.  Montague.) 

Wm.  K.,  English  farm  hand.  Family  history 
as  follows  : — Father  living  and  healthy,  mother 
died  at  52  years  of  age  from  enteritis.  Sisters 
healthy.  Three  brothers  dead,  two  of  whom 
died  in  infancy,  the  other  in  early  manhood,  o^ 
what  disease  he  does  not  know.  Has  been 
temperate  in  his  habits,  and  remembers 
being  sick  but  once  in  his  life  until  very  re- 
cently. At  that  time  which  was  in  his  child- 
hood, had  some  form  of  fever.  Dates  rise  of 
present  illness  to  February,  1881.  At  that 
time  caught  a  heavy  cold.  Noticed  very  severe 
pain  in  his  left  side.  This  pain  lasted  about 
twenty-four  hours.  After  this  attack  was  very 
weak,  had  a  slight  cough  and  very  great  diffi- 
culty in  breathing. 

In  May  following  had  an  attack  of  rheuma- 
tism. Patient  "felt  miserable"  and  was  slowly 
losing  flesh  until  middle  of  June.  At  that 
time  was  seized  with  a  sudden  and  violent  fit 
of  coughing  which  lasted  for  about  an  hour.  It 
came  on  again  the  following  day,  when  he  spat  up 
a  large  amount  of  purulent  matter.  Continued 
in  this  condition  until  admitted  to  the  Hospital, 
at  which  time  he  was  weak  and  very  much 
emaciated.  His  appetite  very  poor,  his  cough 
very  troublesome.  He  lay  constantly  on  his 
left  side.  On  changing  to  his  back  or  right 
side,  or  on  rising  a  distressing  cough  came 
on.  Had  very  marked  hectic.  Bowels  regular 
and  urine  normal. 

Physical  examination  revealed  very  slight 
respiratory  movement  on  left  side.  Left  chest 
measured  1|  inches  more  than  the  right,  bulg- 
ing of  intercostal  spaces.  Dullness  on  percus- 
sion over  the  whole  of  left  lung.  Absence  of 
tactile  fremitus  and  suppression  of  respiratory 
sounds.  Apex  beat  of  heart  heard  near  the 
centre  of  chest. 


Dr.  McFarlane  operated  on  October  10th,  by 
introducing  a  ^  inch  trocar  and  canula  between 
the  6th  and  7th  ribs.  The  trocar  was  with- 
drawn and  a  rubber  tube  inserted  through  the 
canula  and  left  in  the  chest,  being  secured  by 
means  of  adhesive  plaster.  An  exceedingly 
large  quantity  of  thick  pus  was  drawn  oS,  and 
subsequently  the  cavity  was  washed  out  with 
a  weak  antiseptic  solution.  The  washings  were 
continued  twice  a  day  for  about  ten  days, 
afterwards  once  a  day  till  the  3rd  of  November, 
when  the  tube  was  removed.  The  cough  ceased 
and  the  appetite  improved  almost  immediately 
after  the  operation.  The  patient  left  the  Hos- 
pital about  the  15th  of  November,  quite  re- 
covered and  in  good  general  health. 


TOXIC  EFFECTS  OF  NITRO-GLYCE- 
RINE. 

BY   E.    BARRINGTON  NEVITT,  B.A,,  M.B., 

Surgeon  to  the  Hospital  for  Sick  Children,  the  House  of 
Providence,  and  the  Toronto  Dispensary. 

A,  B.,  a  florid  healthy-looking  man  of 
about  40,  by  occupation  a  contractor,  having  a 
great  deal  to  do  in  constructing  drains,  makes 
use  of  dynamite  cartridges.  He  frequently 
carries  one  of  the  cartridges  about  with  him  in 
his  bare  hand  for  the  purpose  of  warming  it 
The  cartridges  are  made  of  paper,  and  the  nitro- 
glycerine often  leaks  through,  staining  the 
paper.  He  has  noticed  on  one  or  two  occa- 
sions a  stinging  sensation  when  he  had  a  cut 
or  crack  on  his  hand.  After  this  within  a  few 
minutes  he  would  be  seized  with  an  intense  head- 
ache, flushing  of  the  face,  singing  in  the  ears,  and 
a  feeling  as  though  the  head  were  enormously 
enlai-ged  and  swollen,  together  with  a  palpita- 
tion of  the  heart.  At  other  times  the  headache 
would  not  come  on  until  night,  after  his  return 
from  work.  It  would  then  occur,  accompanied 
by  the  same  symptoms  as  during  the  day,  and 
was  traced  to  his  usual  custom,  after  washing 
his  hands  as  thoroughly  as  possible,  of 
touching  his  tongue  with  the  fingera,  to  see 
if  all  the  dynamite  was  washed  ofi".  It  was 
only  when  he  tasted  a  peculiar  sweetish  taste 
that  the  headaches  were  found  to  supervene. 
After  being  advised  of  the  probable  cause  of 
these  symptoms  he  used  gloves  when  handling 
the  cartridges,  and  did  not  taste  his  fingers,  and 
has  since  had  no  sensations  of  the  above 
character. 


46 


CANADIAN  JOURNAL 


^tUcilm^ :  ^If tlicine. 


SAUNDBY  ON   THE  TREATMENT  OF 
CONSUMPTTON. 

Dr.    Robert   Saiindby,  in   the    Practitioner, 
October,  1881,  p.   249,  gives  a  very  valuable 
resuTue   of   this    subject.      Cod -liver    oil   aud 
quinine  are  Dr.  Saundby's  sheet  anchors,  the 
hypophosphites  having  disappointed  his  expec- 
tations.    Good  nourishment   and  attention  to 
the  digestive  functions  form  the  best  treatment 
of  cough.     If  a  consumptive  patient  want  to 
take  a  short  cut  to  the  next  world,  he  has  only 
to   take    an    opiate,   paregoric    for    example. 
Codeia  is  most  valuable.     Camphor  inhaled,  a 
lump  under   the   pillow,  or   some   powder  in 
a  jug  of    boiling    water,  forms    an    effectual 
anodyne.     To  prevent  dryness  of  the  mouth,  a 
compressed  tablet  of  chlorate    of  potash  and 
borax    in    the   cheek   remains  all    night,    and 
causes  sufficient  salivary  secretion  to  keep  the 
air-passages  moist.     The  bronchitic  attacks  are 
to  be   met   by  the    use    of  turpentine   vapour 
and  counter-irritation,  and  sulphur  internally. 
Nothing  controls  the  profuse  secretion  of  the 
bronchial     mucous    membrane    so    readily    as 
fifteen  to   twenty   grains  of  sulphate  of  iron, 
given  in  pills  or  mixture  during  the  day.     The 
use  of  oro-nasal  inhalei-s,  charged  with  carbolic 
acid  or  eucalyptus  oil,  is  strongly  advocated. 
For  anorexia,   qxiinine   does   more   than   any 
other  drug ;   while   the  peptones,  Hofi's  malt 
extract,    and   such    like   preparations,    are,  in 
many  cases,  mo:it  valuable.     Cod-liver  oil,  in 
doses  of  one  teaspoonful,  after  meals,  thrice  a 
day,  Dr.  Saundby  believes  to  be  quite  sufficient, 
larger  doses  not  being  assimilated.     The  diar- 
rhcEa   is   always   controlled    by  two   drachms 
of  dilute  sulphuric  acid  to  the  pint  of  sugared 
orange-water,  drunk  ad  libitum,  unless  ulcera- 
tion be  present ;  and  then  starch  and  laudanum 
enemata,   or   an  enema  of  half  an   ounce   of 
liquid  extract  of  ergot,  will,  in  most  cases,  give 
relief.     The    sweating   is   generally  controlled 
by   the    same   means    as    are    used    for   the 
diarrhoea ;  but  if  not,  then  atropine  or  picro- 
toxinemust  be  used.  Haemoptysis  Dr.  Saundby 
treats     with      ergot     internally     or      subcu- 
taneously.      In  conclusion,   a  tabulated   view 


is  given  of  the  different  remedies.  Specific : 
quinine,  cod-liver  oil  :  Cough  :  liquorice,  cam- 
phor, codeia  lozenges  ;  Bronchitis  :  turpentine 
inhalations  and  epithems  ;  Purulent  expectora- 
tion :  eucalyptus  inhalation,  sulphate  of  iron  ; 
Anorexia  :  quinine,  peptonised  food,  malt  ex- 
tracts, cod-liver  oil,  ether,  alcohol ;  Diarrhoea  : 
sulphuric  acid,  ergot,  ergotine.  A  good  pre- 
scription in  many  cases  is  the  following : 
R  Quinae  sulphatis,  gr.  j  ;  specific,  tonic  ;  Ferri 
sulphatis,  gr.  v;  for  profuse  expectoration; 
Acidi  sulphurici  diluti,  wxv ;  for  sweating, 
diarrhoea,  and  haemoptysis  ;  Aquse,  ad  ^j.  M. 
To  be  taken  thrice  daily.  If  the  sweating  be 
not  hereby  checked,  a  minim  of  solution  of 
sulphate  of  atropine  may  be  added,  and  codeia 
lozenges  may  be  given,  with  cod-liver  oil  in 
addition,  if  need  be. — Richard  Neale,  M.D. — 
London  Medical  Record. 
■  ■♦>  ■ 

MYOGEDEMA. 

Idio-muscular  contraction  or  myooedema  is 
the  name  given  to  the  phenomenon  produced 
in  a  muscle  when  a  sudden  local  stimulus  is 
applied  to  it,  as  the  tap  of  the  index  finger, 
causing  a  small  quickly -vanishing  nodule  to 
appear  at  the  part  struck.  M.  D.  LabbI  has 
lately  been  investigating  the  semeiological  value 
of  this  phenomenon  in  certain  morbid  condi- 
tions. 

Its  seat  of  predilection  is  the  front  of  the 
thorax,  where  it  may  best  be  produced  by  a 
sharp,  sudden  stroke  of  the  index  finger.  After 
four  or  five  shocks,  the  muscle  becomes  ex- 
hausted, and  requires  15  or  30  minutes'  rest 
before  it  will  again  respond  to  the  stimulus. 
Physiologically,  its  volume  is  that  of  a  lentil  or 
coffee  bean,  its  duration  two  or  three  seconds, 
and  it  is  produced  equally  upon  either  side  of 
the  thorax.  Pathologically,  its  duration  is  ex- 
aggerated to  5  or  15  seconds,  its  size  increased 
to  that  of  a  nutmeg,  an  olive,  or  an  almond, 
and  it  is  unequal  upon  the  two  sides  of  the 
thorax. 

Lawson  Tait  describes  two  varieties — 1st,  the 
most  common,  the  instantaneous  production  of 
the  nodule  upon  the  part  struck ;  2nd,  Storr'a 
nodule,  produced  by  the  meeting  of  two  con- 
tractile muscular  currents,  which  set  out  from 
opposite  extremities  of  the  muscular  fibres. 


OF  MEDICAL  SCIENCE. 


47 


Lawson  Tait  considers  that  myocedema  is  a 
certain  sign  of  pulmonary  tuberculosis,  both  in 
its  fully  developed  and  latent  forms.  He  also 
considers  that  it  is  a  certain  indication  of  a 
softening  tubercle  deposit,  and  that  its  in- 
tensity bears  a  direct  ratio  to  the  rapidity  and 
to  the  amount  of  pulmonary  destruction.  The 
phenomenon  is  always  more  marked  upon  the 
side  which  is  the  more  diseased,  M.  Labb6's 
researches  have  not  led  him  to  agree  with  these 
views  in  toto.  He  believes  that  myocedema 
ought  to  attract  attention  to  the  chest  and 
lungs — he  states  that  this  sign  was  the  first 
that  drew  his  attention  to  the  lungs  in  many 
cases,  but  that  in  many  others  the  sign  was 
coincident  with  advanced  lesions. 

He  concludes  that  it  is  not  the  exclusive 
appanage  of  pulmonary  tuberculosis,  nor  still 
less  of  tubercular  softening,  having  been  ob- 
served in  pleurisy,  pneumonia,  and  enteric 
fever ;  and  that,  without  being  a  decisive  Sign 
it  ought  to  be  admonitory  and  may  be  confirm- 
atory. 


POISONING  BY  ACONITE. 

Dr.  E.  T.  Reichert  [Philadelphia  Medical 
Times,  November  19th,  1881)  gives  an  analysis 
of  the  treatment  of  forty-one  cases  of  aconite 
poisoning.  Evacuation  of  the  stomach,  the 
administration  of  large  doses  of  stimulants,  and 
the  use  of  external  stimuli,  was  the  system  of 
treatment  pursued  in  the  majority  of  cases. 
Opium  and  its  preparations  were  used  in  four 
cases,  all  of  which  terminated  favourably.  In 
one  case,  five  and  a  half  drachms  of  laudanum 
were  administered  in  four  hours  without 
causing  narcotism.  Digitalis  was  adminis- 
tered in  two  cases,  in  connection  with  other 
stimulants.  One  died,  and  one  recovered. 
The  latter,  who  had  taken  an  ounce  of 
Fleming's  tincture  of  aconite,  received  three 
hypodermic  injections,  each  of  twenty  minims 
of  tincture  of  digitalis,  within  an  hour.  Amyl- 
nitrite  was  used  with  very  marked  results  in 
one  case,  and  certainly  deserves  an  extended 
trial  in  poisoning  by  aconite  as  it  is  a  marked 
cardiac  stimulant.  Tincture  of  nux  vomica 
was  used  in  one  case,  with  marked  benefit  to 
the  heart  and  respiration. —  British  Medical 
Journal. 


Fat  in  thb  Urine. — Rassman  (Allgemeine 
Medicinische  Central  Zeitung,  August  3rd, 
1881),  claims  that  fat  is  found  in  the  urine  in 
three  classes  of  affections : — First.  True  chyluria, 
parasitic,  and  non-parasitic.  In  these  cases  the 
urine  generally  contains  albumen  also,  and  not 
infrequently  fibrin.  Second.  Fatty  degenera- 
tion at  some  point  of  the  urinary  apparatus. 
To  this  class  belong  all  those  cases  where  the 
pus  of  an  old  abscess  finds  its  way  into  the 
urinary  passages.  Third.  Constitutional  affec- 
tions, associated  with  marked  cachexia  or  sys- 
temic intoxication,  as  phthisis,  cancer,  long- 
continued  suppuration,  pysemia  yellow  fever, 
phosphorus  or  carbonic  oxide  gas  poisoning, 
chronic  poisioning  by  turpentine,  and  severe 
injuries  of  the  bones.  In  these  cases  the  blood 
contains  an  abnormal  amount  of  fat,  which. 
passes  off  by  the  kidneys.  As  a  proof  of  the 
correctness  of  this  theory,  Rassman  cites  a 
series  of  experiments  on  dogs,  cats,  rabbits,  and 
frogs.  After  injections  of  oily  emulsions  into 
the  blood  or  peritoneal  cavity,  fat  was  demon- 
strable in  the  urine  on  microsopic  examina- 
tion. At  the  same  time  the  animals  became 
somnolent,  the  blood-pressure  temporarily  sank, 
and  the  pulse  became  less  frequent.  When  fat 
was  injected  in  large  quantities,  death  ensued 
in  a  short  time,  the  heart  becoming  arrested 
in  the  state  of  diastole.  Similar  results  were 
obtained  after  injectioas  of  emulsified  oleic  acid 
and  oleate  of  soda  in  one  to  ten  per  cent,  solu- 
tions. Rassman  agrees  with  Olshausen,  in 
believing  that  these  phenomena  furnish  an  ex- 
explanation  of  the  retardation  of  the  pulse 
during  the  first  few  days  lollowing  childbirth ; 
in  other  words,  this  retardation  is  due  to  fatty 
degeneration  of  the  uterus  and  abundant  ab- 
sorption of  fat  into  the  blood. — Chicago  Medi- 
cal Review. 


Prior  on  the  Treatment  of  Diabetes 
Insipidus. — Dr.  Prior,  in  the  Lancet,  October, 
1881,  p.  662,  reports  a  case  of  this  disease 
in  which  large  doses  of  valerianate  of  zinc  (ten 
to  twelve  grains  three  times  a  day),  given  in 
combination  with  tincture  of  valerian  in  two- 
drachm  doses  was,  after  two  months'  perse- 
verance, followed  by  a  perfect  cure. — London, 
Medical  Record. 


48 


CANADIAN  JOURNAL 


Treatment  of  Tonsillitis  and  Hypertro- 
phy OF  THE  Tonsils  by  Bicarbonate  of  Soda. 
— Dr.  Aruiangue  reports  in  Jievue  de  Thera- 
peutique  seven  cases  of  tonsillitis  cured  in  less 
than  twenty-four  houi-s  by  the  bicarbonate  of 
soda.  This  method  of  treatment  was  intro- 
duced by  Dr.  Gine,  Professor  of  Clinical  Sur- 
gery, who  employed  bicarbonate  of  .-oda  Jo  ally 
either  by  insufflatiou,  or  directly  applied  by  the 
finger  of  the  patient.  The  applications  should 
be  frequently  repeated  until  the  disease  disap- 
pears. Dr.  Gin6  relates  dozens  of  cases  in 
which  a  cure  was  accomplished  in  less  than 
twenty-four  hours,  and  has  never  seen  this 
method  fail  to  produce  a  good  effect.  The 
alleviation  is  almost  always  immediate,  and  is 
never  long  delayed.  Jts  efficacy  is  especially 
marked  in  the  prodromic  period  of  tonsillitis, 
when  it  will  invariably  abort  the  disease. 
According  to  Dr.  Gine,  bicarbonate  of  soda 
does  not  diminish  the  predisposition  to  anginas, 
but  only  arrests  their  development.  Excision 
of  the  tonsils  is  a  useless  operation  iu  cases  of 
hypertrophy  of  the  tonsils,  since  the  hyi)ertro- 
phy  can  be  rapidly  removed  by  frequent  appli- 
cation of  the  salt  of  soda. — Wnion  Med.  du 
Canada,  Dec,  1881. — Medical  News. 

.  ^*m  ■ 

Williams  on  Tannin  in  Diphtheria. — 
Dr.  A.  Wynn  Williams,  in  the  British  Medical 
Journal,  October,  1881,  p.  654,  claims  for  the 
local  application  of  tannin  all  the  value  that 
he  maintained  this  drug  possessed  in  1867, 
when,  before  the  Obstetrical  Society,  Dr. 
Williams  read  a  paper  on  the  treatment  ot 
diphtheria.  The  deposit,  pharacteristic  of  the 
disease,  is  almost  instantaneously  removed  by 
the  free  application  of  a  solution  of  tannic 
acid,  two  drachms ;  rectified  spirits  of  wine, 
two  drachms ;  and  of  water,  six  drachms. — 
Lortdon  Medical  Record. 


Ether  Uypodermically  in  Adynamic 
Pneumonia. — Dr.  Barth,  ot  LaPiiie  Hospital, 
Paris,  recommends  the  Jiypodermic  u^e  of 
ether  in  all  adynamic  cases  of  pneumonia, 
typhoid  fever,  puerperal  fevur,  &c.  He  injects 
2  grammes  (jss)  per  diem.  Of  14  cases  of 
adynamic  pneumonia  under  his  care,  11  re- 
covered. 


Kleudgen  on  Albuminuria  in  Epilepsy. 
— The  author's  conclusions  are  these.  There 
are  traces  of  albumen  in  all  urine  which  pre- 
sents a  certain  degree  of  concentration  (an 
increased  specific  gravity).  Slight  increases  in 
the  quantity  of  albumen  may  occur  periodically 
without  a  corresponding  rise  in  the  specific 
gravity,  and  without  the  existence  of  renal 
disease.  The  urine  secreted  after  an  epileptic 
attack  does  not  present  any  peculiarity,  either 
in  reaction  or  in  specific  gravity.  It  is  very 
rare  that  an  attack  of  epilepsy  determines  an 
augmentation  of  the  quantity  of  albumen  in 
the  urine ;  when  this  occui-s  it  is  only  very 
slight ;  moreover,  in  males  it  is  generally  due 
to  the  presence  of  semen  in  the  urine.  Renal 
casts  are  not  found  in  the  urine  of  epileptics 
unless  kidney-disease  be  present.  —  London 
Medical  Record. 

■  iM^fc    ■ 

Fil/ATOFF   ON    the    EtIOLOGY  AND    DIAGNOSIS 

OF  Acute  Peritonitis  of  Children. — The 
diagnosis  of  acute  peritonitis  offers  no  diffi- 
culty, so  characteristic  are  the  symptoms  ;  but 
the  explanation  of  a  cause  is  not  always  so 
easy,  and  in  many  cases  is  quite  unknown, 
or  included  iu  the  vague  term  rheumatic.  Dr. 
Filatoff,  after  pointing  this  out,  proceeds  to 
recount  a  case  in  which  all  the  n^arked 
symptoms  of  the  disease  were  present,  and 
which  he  considered  was  due  primarily  to  a 
straining  of  the  abdominal  muscles  by  excessive 
gymnastic  exercise,  followed  by  improper  diet. 
He.  refers  to  another  case,  in  which  the 
symptoms  of  acute  peritonitis  were  closely 
simulated  by  an  affection  of  the  recti  ab- 
dominis, also  brought  on  by  excessive  gym- 
nastics.— London  Medical  Record. 
' ■  ■♦■  « 

Atkinson  on  Nitrite  of  Amyl  and  Nitro- 
glycerine in  the  Treatment  of  Toothache. 
— Dr.  Atkinson  finds  [Practitioner,  October, 
1881,  p.  263)  that  ootton-wool,  steeped  in  a 
one  per  cent,  solution  of  nitro-glycerine,  ap- 
plied to  a  decayed  tooth,  will  give  instant 
relief;  if,  so  soon  as  the  pain  has  ceased, 
laudanum  be  applied  by  means  of  fresh  cotton- 
wool, the  pain  may  be  kept  off"  regularly 
for  four  hours  or  more  at  a  time. — London 
Medical  Record. 


OF  MEDtCAL  SCIENCE. 


49 


Chloral  Poisoning. — Dr  Cameron  reported 
at  Moatreal  Medico-Chirurgical  Society  a 
case  of  a  lady  who  took  one  hundred  and 
sixty  grains  of  chloral  hydrate  at  a  single  dose, 
for  suicidal  purpose.  When  seen  three  hours 
aftei',  the  pulse  was  eighteen,  the  pupils  con- 
tracted, features  pale.  Believing  that  the 
chief  indication  was  to  support  the  failing 
heart,  chloric  aether,  J/xxx.,  was  injected  sub- 
cutaneously  eveiy  half  hour  for  four  doses, 
with  marked  improvement  of  the  pulse  and 
general  symptoms.  Emetics  were  employed, 
but  very  little  came  up  in  the  vomiting.  The 
patient  made  a  good  recovery.  Dr.  Proudfoot 
mentioned  that  in  Boston,  when  chloral  first 
came  into  use,  he  gave  sixty  grains  an  hour, 
for  six  hours,  to  a  man  with  delirium  tremens. 
No  dangerous  symptoms  followed ;  so  far  as  he 
knew,  the  drug  was  good,  having  been  imported 
from  Germany. — Medical  News, 

— — «-♦■  ■ 

SoBEL  ON  Treatment  of  (Edema  of  the 
Glottis  by  Pilocarpine. — M.  Sorel,  who  is  a 
military  Surgeon  at  Setif,  Algeria,  sent  to  the 
Societe  de  Therapeutique  in  Paris  {Jour,  de 
Med.  de  Paris),  a  case  of  oedema  of  the  glottis 
consecutive  on  typhoid  fever,  and  cured  by 
pilocarpine.  A  previous  application  of  fifteen 
leeches  had  not  given  any  relief.  Ipecacuanha 
had  no  efiect  whatever,  and  subcutaneous  in- 
jections of  moi-phia  had  only  given  temporary 
relief.  Almost  in  despair,  M.  Sorel  tried  an 
injection  of  a  centigramme  of  nitrate  of  pilo- 
carpine. A  slight  perspiration  appeared,  and 
the  troublesome  symptoms  were  removed.  On 
the  same  evening  a  fresh  injection  of  a  centi- 
gramme was  made,  and  on  the  next  day  two 
centigrammes.  The  patient  soon  recovered  his 
strength,  and  became  convalescent. 

Kidney  Tumours. — At  the  Pathological 
Society  of  London,  in  November,  Mr.  Eve 
showed  a  striped  muscle  tumour  of  the  kidney. 
This  is  said  to  be  the  sixth  on  record,  but  the 
enumeration  does  not  appear  to  include  one 
of  Osier's,  of  Montreal. 

At  the  same  meeting  Dr.  Dawson  Williams 
showed  a  tumour,  which  he  had  removed  from 
a  child  13  months  old,  occupying  the  place  of 
the  right  kidney.  It  weighed  1  lb.  13^  oz.,  or 
nearly  ^th  of  the  total  body  weight.  On  ex- 
amination, it,  too,  was  proved  to  contain 
striated  muscular  fibres. 


^mm^. 


SELECTIONS    FROM    CLINICAL    LEC- 
TURES, DELIVERED  AT  THE 
LONDON  HOSPITAL. 

BY  JONATHAN  HUTCHINSON,  F.R.C.S. 

THE  PRE-CANCEROUS  STAGE  OF  CANCER,  AND  THE 
IMPORTANCE  OF  EARLY  OPERATIONS. 

Gentlemen, — The  patient  who  has  just  left 
the  theatre  is  the  subject  of  cancer  of  the 
tongue  in  an  advanced  stage.  As  I  demon- 
strated to  you,  the  lymphatic  glands  are  already 
enlarged.  It  is  hopeless  to  think  of  an  opera- 
tion, and  there  is  nothing  before  him  but  death, 
preceded  and  produced  by  a  few  months  of 
great  and  continuous  suffering.  His  case,  I 
am  sorry  to  say,  is  but  an  example,  of  what  is 
very  common.  Not  a  month  passes  but  a  case 
of  cancer  of  the  tongue  presents  itself  in  this 
condition.  The  cases  which  come  whilst  the 
disease  is  still  restricted  to  the  tongue  itself 
are  comparatively  few  ;  noi*  does  this  remark 
apply  only  to  the  tongue.  "  Too  late !  Too 
late  !  "  is  the  sentence  written  but  too  legibly 
on  three-fourths  of  the  cases  of  external  cancer 
concerning  which  the  operating  surgeon  is  con- 
sulted. It  is  a  most  lamentable  pity  that  it 
should  be  so  ;  and  the  bitterest  reflection  of 
all  is,  that  usually  a  considerable  part  of  the 
precious  time  which  has  been  wasted  has  been 
passed  under  professional  observation  and 
illusoiy  treatment.  In  the  present  instance, 
the  poor  fellow  has  been  three  months  in  a 
large  hospital,  and  a  ra  nth  under  private  care, 
r  feel  free,  gentlemen,  to  speak  openly  on  this 
matter,  because  my  conscience  is  clear  that  I 
have  never  failed  when  opportunity  offered, 
both  here  and  elsewhere,  to  enforce  the  doc- 
trine of  the  local  origin  of  most  forms  of 
external  or  surgical  cancer,  and  the  paramount 
importance  of  early  operation.  I  have  tried 
every  form  of  phraseology  that  I  could  devise, 
as  likely  to  impress  this  lesson.  Nearly  twenty 
years  ago,  I  spoke  to  your  pi'edecesors  in  this 
theatre  concerning  thu  "  successful  cultivation 
of  cancer;"  telling  them  how,  if  they  wished 
their  patients  to  die  miserably  of  this  disease, 
they  could   easily  bring  it  about.     The  sugges- 


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tion  was,  that  all  suspicious  sores  should  be 
considered  to  be  syphilitic,   and  treated  inter- 
nally by  iodide  of  potassium,   and  locally  by 
caustics,    until   the    diagnosis    became   clear. 
More  recently,  I  have  often  explained  and  en- 
foxxjed  the  doctrine  of  a  pre-cancerous  stage  of 
cancer,  in  the  hope  that,  by  its  aid,  a  better 
comprehension  of  the  importance  of  adequate 
and  early  treatment  might  be  obtained.     Ac- 
cording  to   this    doctrine,   in   most   cases    of 
cancer   of  the    penis,    lip,    tongue,    skin,   etc., 
there   is  a   stage — often    a  long   one — during 
which  a  condition  of  chronic  inflammation  only 
is  present,  and  ujion  this  the  cancerous  process 
becomes  engrafted.     I  feel  quite  sure  that  the 
fact   is    so.       Phimosis     and    the    consequent 
balanitis  lead  to  cancer  of  the  penis  ;  the  soot- 
wart  becomes  cancer  of  the  scrotum  ;  the  pipe- 
sore  passes  into  cancer   of  the    lip ;    and   the 
syphilitic   leucoma   of   the    tongue,  which  has 
existed  in  a  quiet  state  for  years,  at  length,  in 
more  advanced  life,  takes  on  cancerous  growth. 
The  frequency  with  which  old  syphilitic  sores 
become  cancerous  is  very  remarkable ;  on  the 
tongue,  in  particular,  cancer  is  almost  always 
preceded    by  syphilis,    and  hence    one    of   the 
commonest    causes   of  error  in    diagnosis   and 
procrastination    in    treatment.       The   surgeon 
diagnoses    syphilis,    the     patient    admits    the 
charge,  and  iodide  of  patassium   seems  to  do 
good ;  and  thus  months  are  allowed  to  slip  by 
in  a  state  of  fools'  paradise.     The  diagnosis, 
which  was  right  at  first,  becomes  in  the  end  a 
fatal  blunder,  for  the   disease  which    was  its 
subject  has  changed  its  nature.     I  repeat  that 
it  is  not  possible  to  exaggerate  the  clinical  and 
social  importance  of  this  doctrine.     A  general 
acceptance  of  the  belief  that  cancer  usually  has 
a  pre-cancerous  stage,  and  that  this  stage  is 
the  one  in  which  operations  ought  to  be  per- 
formed,  would  save   many   hundreds   of  lives 
every  year.     It  would  lead  to  the  excision  of 
all  portions  of  epithelial  or  epidermic  structure 
which  have  passed  into  a  suspicious  condition. 
Instead  of  looking  on  whilst  the   fire  smould- 
ered, and  waiting  till  it  blazed  up,  we  should 
stamp  it  out  on  the  first  suspicion.     What  is  a 
man  the  worse  if  you  have  cut  away  a  warty 
sore  on  his  lip,  and,   when  you  come    to   put 
sections  under    the    microscope,   you    find   no 


nested  cells  1  If  you  have  removed  a  painful, 
hard  based  ulcer  of  the  tongue,  and  with  it 
perhaps  an  eighth  |)art  of  the  organ ;  and, 
when  all  is  done,  and  the  sore  healed,  a  zealous 
pathological  friend  demonstrates  to  you  that 
the  ulcer  is  not  cancerous,  need  your  conscience 
be  troubled  1  You  have  operated  in  the  pre- 
cancerous stage,  and  you  have  probably  effected 
a  permanent  cure  of  what  would  soon  have 
become  an  incurable  disease.  I  do  not  wish  to 
offer  any  apology  for  carelessness,  but  I  have 
not  in  this  matter  any  fear  of  it. 

PROMPT   AMPUTATION  IN  TRAUMATIC    GANGRENE  : 
IMPORTANCE  OF  AMPUTATION  HIGH  UP. 

In  cases  of  traumatic  gangrene,  ought  am- 
putation to  be  performed  without  waiting  for 
a  line  of  demarcation  to  be  formed  1  I  believe 
that  the  reply  of  most  surgeons  to  this  ques- 
tion will  be  an  unhesitating  afiirmative. 
Such  certainly  would  be  my  own.  We  have 
recently  had  a  very  instructive  case.  A  man 
aged  more  than  50,  but  of  good  constitution, 
was  admitted  with  a  compound  fracture  of  the 
lower  third  of  the  leg.  We  tried  to  save  it, 
and  the  limb  was  put  up  in  antiseptic  dress, 
ings.  The  foot,  however,  became  gangrenous, 
and,  about  the  sixth  day  after  admission,  Mr. 
Tay  amputated  the  limb  below  the  knee,  the 
man  being  at  the  time  very  ill.  The  amputa- 
tion was  done  through  perfectly  sound  parts- 
but  it  was  presently  followed  by  gangrene  of 
the  stump.  The  flaps  became  livid,  and  the 
man  was  in  a  most  urgent  condition.  Mr. 
Tay  and  myself,  in  consultation,  determined 
at  once  to  perform  a  second  amputation  ;  and, 
within  twenty -four  hours  of  the  first,  this  was 
done  in  the  lower  third  of  the  thigh.  The 
man  did  well,  and  the  stump  on  the  second 
occasion  has  made,  as  you  saw  the  other  day,  a 
very  good  one.  The  main  reason  for  prompt 
amputation  in  such  cases  is,  that  the  gan- 
grenous process  is  a  very  dangerous  one. 
Whilst  soft  parts  are  dying,  and  the  circula- 
tion still  going  on  to  some  extent  through 
them,  the  blood  becomes  poisoned  by  the 
absorption  of  gases  and  fluids  from  the  putres- 
cent parts,  and  a  most  dangerous  condition  of 
septicaemia  results.  Of  this  state,  a  rapid 
pulse,  a  sunken  countenance,  high  temperature, 


OF  MEDICAL  SCIENCE. 


&i 


and  vomiting,  are  the  most  constant  signs.  It 
is  remarkable  how  quickly  they  are  sometimes 
relieved  by  the  removal  of  the  dying  part.  It 
may  be  that  the  process  of  mortification  is  also 
attended  by  shock  to  the  nervous  system,  but 
I  suspect  that  the  chief  part  of  the  mischief  is 
done  through  the  blood.  In  the  pyaemia 
which  results  from  phlebitis,  it  is  of  no  use  to 
amputate  after  once  the  poisonous  emboli  have 
been  shed  from  the  inflamed  vein  into  the 
blood.  It  is  then  too  late,  for  the  secondary 
abscesses  will  form,  whether  you  remove  the 
original  focus  or  not.  In  the  septicsemia  from 
gangrene,  however,  the  case  is  different.  Here 
it  seems  to  be  easily  possible  for  the  blood  to 
rid  itself  of  the  contamiaation.  I  well 
remember  the  case  of  a  young  soldier  who  was 
under  treatment  some  years  ago  for  a  damaged 
foot,  the  consequence  of  a  Canadian  frost-bite. 
He  had  also  obliteration  of  his  femoral  artery. 
My  junior  colleague  at  the  time  amputated 
through  the  tarsus.  The  stump  never  healed, 
and,  some  time  later,,  I  amputated  in  the  upper 
third  of  the  leg  at  a  great  distance  from  the 
disease,  for  the  whole  of  his  leg  looked  at  the 
time  as  healthy  as  yours  or  mine.  I  went 
high  up,  because  I  knew  that  the  femoral 
artery  was  occluded.  The  result,  however, 
was,  that  the  stump  passed  into  gangrene,  and 
very  soon  we  had  all  the  symptoms  of  the 
most  severe  form  of  that  malady.  The  patient 
had  frequent  vomiting,  a  very  rapid  pulse,  and 
was  indeed  in  such  a  critical  state  when  on  the 
third  day  I  decided  to  amputate  again,  that  I 
did  not  dare  to  have  him  taken  from  his  bed. 
The  second  amputation,  performed  high  up  in 
the  thigh,  saved  his  life.  No  ill  symptoms 
occurred  after  it,  and  the  stump  healed  well. 
I  am  inclined  to  believe  that  the  usefulness  of 
amputation  in  gangrene  will  become  more 
widely  appreciated,  and  that  this  measure  will 
be  resorted  to,  not  exclusively  in  traumatic 
gangrene,  but  in  all  forms  which  are  attended 
by  serious  constitutional  symptoms.  If  a  part 
be  simply  passing  quietly  into  a  mummified 
condition,  and  the  patient's  health  not  suffer- 
ing, then  there  is  no  reason  for  interfering 
until  you  see  where  nature  is  going  to  make 
the  separation.  There  is,  indeed,  no  reason 
for  interfering  at  all,  for  you  must  let  nature 


finish  the  work.  If  you  amputate  near  to  the 
line  of  demarcation,  your  stump  is  almost  cer- 
tain to  slough,  and  all  that  you  must  dare  do 
in  the  way  of  help  in  such  cases  is  just  to  saw 
through  the  bones  when  they  are  laid  bare. 
The  explanation  of  disappointment  in  ampu- 
tating for  gangrene,  whether  traumatic  or 
otherwise,  is,  I  feel  sure,  almost  always  from 
amputating  too  near  to  the  disease.  In  all 
such  cases,  we  ought  always  to  go  high  up. 
If  the  foot  be  concerned,  go  above  the  knee  ; 
if  the  upper  extremity,  near  to  the  shoulder. 
You  must  think  rather  of  the  patient's  life 
than  of  the  length  of  his  stump.  Adopting 
this  rule,  I  have  of  late  years  more  than  once 
amputated  for  severe  forms  of  senile  gangrene 
with  very  excellent  results. 

CAN  A  MAN  HAVE  SYPHILIS  TWICE  ] 

The  man  whom  we  have  just  seen  offers  a 
remarkable  example  of  the  occurrence  of  a 
second  chancre  soon  after  the  first.  His  second 
sore  has  been,  as  I  have  repeatedly  demon- 
strated, characteristically  indurated.  He  is 
quite  candid,  and  makes  no  doubt  that  this 
sore  was  the  result  of  contagion.  Yet  it  is 
barely  a  year  since  he  had  his  first  chancre, 
and  this  was  followed  by  an  eruption,  of  which 
he  had  scarcely  got  clear  when  this  second  sore 
occurred.  The  case  is  proof  that  a  man  may 
have  an  indurated  sore  on  the  penis  within  a 
year  of  a  former  one,  but  it  is  not  proof  that 
he  may  have  syphilis  twice,  for  this  patient 
has  not  as  yet  had  any  constitutional  symptoms 
as  the  result  of  the  last  chancre.  If,  however, 
you  ask  me  for  an  answer  to  the  general  ques- 
tion. Can  a  man  have  true  complete  syphilis 
twice  1  then  I  must  reply  clearly  that  he  can. 
Such  cases  are  rare — as  rare,  perhaps,  as 
examples  of  second  attacks  of  small-pox — but 
they  do  occur.  I  am  at  present  attending  a 
gentleman  who  has  a  terrible  phagedenic 
chancre  and  rupial  eruption,  and  who  unques- 
tionably had  complete  syphilis,  chancre,  sore- 
throat,  and  rash,  seven  years  ago.  I  have  also 
a  second  case  under  care,  very  much  milder, 
but  illustrating  exactly  the  same  fact,  with 
almost  precisely  similar  dates.  Second 
chancres  are,  however,  far  more  common  than 
second  attacks  of  constitutional  syphilis.   Many 


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of  them  ai-e  the  result  of  fresh  contagion,  but 
seem  to  have  no  power  to  produce  constitu- 
tional symptoms  ;  but  others  are  not  from  con- 
tagion at  all,  but  form  in  connection  with  a 
taint  still  remaining  from  the  first  attack.  It 
is  a  most  important  fact  that  indurations  may 
form  in  the  |>eni8  in  every  respect  likfi  Huu- 
terian  chancres,  not  distinguishable  in  any 
way,  and  yet  that  they  may  be  merely  recurred 
sores,  and  the  products  of  constitutional  taint. 
I  have  seen  this  over  and  over  again  ;  and  M. 
Alfred  Fournier,  of  the  St.  Louis  Hospital,  has 
written  a  very  instructive  paper  on  this  form 
of  sore.  In  the  case  of  our  patient,  it  is 
obviously  impossible  to  say,  after  the  statement 
which  I  have  just  made,  whether  or  not  his 
present  sore  is  the  result  of  fresh  contagion. 
It  may  be  simply  a  relapse,  or  it  may  be  a 
gumma.  He,  however,  confesses  to  exposure ; 
and,  as  the  sore  followed  in  due  course,  it  is 
probably  true  that  he  was  afresh  inoculated. 
Second  attacks  of  syphilis  are  sometimes,  as 
in  the  case  just  mentioned,  very  severe,  The 
same  has,  I  believe,  been  occasionally  noted 
in  recurred  attacks  of  variola.  As  a  rule, 
however,  they  are  mild,  or  even  abortive. 
Third  attacks  may  even  occur  ;  and  so  may,  as 
we  are  told,  third  attacks  of  small-pox.  We 
must  explain  such  facts,  I  expect,  by  reference 
to  individual  peculiarity  and  idiosyncrasy,  but 
it  is  important  that  they  should  be  known- 
The  belief  that  syphilis  can  occur  but  once  in  a 
lifetime  is  very  widely  s])read  amongst  a  cer- 
tain class  of  the  public.  I  have  watched  with 
amusement  the  change  in  expression  in  n  any 
a  young  gentleman's  face  when  he  got  my  reply 
to  his  smiling  suggestion — "  A  man  cannot,  I 
suppose,  have  the  disease  a  second  time  1 " 

CHRONIC   SYNOVITIS,    ARTHRITIS,    OR    STRUMA  : 
IMPORTANCE  OF  THE  DIAGNOSIS. 

We  have  had  lately  a  great  many  cases  of 
synovitis  of  the  knee-joint.  I  think  you  will 
have  observed  that,  roughly,  we  may  divide  all 
the  cases  of  chronic  synovitis  into  two  groups, 
those  which  are  connected  with  struma,  and 
those  which  are  of  an  arthritic  nature,  in  the 
conventional  sense  of  that  term.  This  division 
is  of  considerable  practical  value.  Under  the 
arthritic  head,  I  comprise  all  that  are  associ- 


ated with  gout,  rheumatism,  or  iheumatic 
gout,  and  all  gonorrhceal  rheumatism  ;  and  of 
all  these,  we  may  say  that  we  expect  them  to 
get  well.  Sometimes  there  is  stiffening,  some- 
times effusion  is  very  long  in  disappearing  ; 
but  still,  in  nearly  all  cases,  in  the  end  the 
patient  again  walks  on  the  limb.  It  is  very 
different  with  the  strumous  group.  Here  the 
tendency  is  to  pulpy  thickening  of  the  synovial 
membrane,  and  to  incurable  conditions.  It 
may  be  that  destructive  changes  are  warded  off 
by  long  rest,  but  the  patient  is  disabled,  and 
the  limb  useless.  We  have  half  a  dozen  of 
this  kind  of  knee  now  in  our  hands,  not  bad 
enough  for  amputation  or  excision,  but  still  so 
bad  as  to  prevent  walking.  In  these  cases,  we 
are  obliged  to  forbid  walking,  whereas  in  most 
of  the  arthritic  cases,  unless  exercise  causes 
pain,  it  may  be  permitted  with  impunity.  A 
considerable  variety  of  conditions  is  presented 
in  this  group,  and  especially  is  the  arthritic 
process  modified  by  the  age  of  the  patient. 
The  older  the  patient,  the  more  chronic  and 
the  less  painful  is  rheumatism.  You  know 
that  I  am  in  the  habit  of  insisting  upon  the 
importance  of  the  patient's  diathesis,  even  in 
cases  of  synovitis  which  is  called  traumatic. 
We  admit  a  great  many  cases  in  which  "'^e 
synovial  effusion  has  followed  a  sprain  or  con- 
tusion. In  these  cases,  if  the  effusion  lasts 
long,  or  if  it  is  in  excess  of  what  its  supposed 
cause  will  account  for,  you  must  suspect  the 
arthritic  diathesis.  The  patient  is  rheumatic  or 
goixty.  We  have  had  numberless  illustrations 
of  this.  Sometimes  it  is  difficult  to  get  at  the 
exact  facts.  In  the  case  of  a  man  who  has 
just  left  us,  the  synovitis  persisted  in  spite  of 
treatment,  and  relapsed  after  an  apparent  cure. 
It  appeared  likely  that  the  case  might  end  as 
hydi'ops  articuli.  I  had  repeatedly  taxed  the 
man  with  being  gouty,  but  we  could  get  but 
little  evidence.  Last  week,  his  employer  called 
on  me ;  I  then  learned  that  the  man  had  been 
for  thirty  years  employed  as  a  bottler  in  wine 
vaults,  and  that  his  habits  of  free  wine  drink- 
ing had  often  nearly  cost  him  his  place.  I 
was  told  that  no  objection  was  made  to  a 
bottler  drinking  as  much  wine  as  was  good  for 
him,  and  that  complaint  only  resulted  when 
80  much  was  taken    as  to  interfere    with   his 


OF  MEDICAL  SCIENCE. 


58 


efficiency  as  a  workman.  It  is  not  easy  to 
imagine  a  position  more  likely  to  produce  a 
gouty  state  of  system.  We  have  since  let  this 
patient  leave  the  hospital,  supplied  with  a 
knee-cap.  He  still  has  some  fluid  in  the  joint, 
but  he  can  walk  without  any  pain.  Exercise 
which  would  of  course  be  most  injurious  if  the 
disease  were  strumous,  will  not  hurt  him. — 
British  Medical  Journal. 


THE  RISKS  OF  INTRA-PLEURAL 
INJECTIONS. 

A  few  years  ago  we  heard  far  more  frequently 
of  fatal  accidents  occurring  during  the  opera- 
tion of  washing  out  an  empyema  than  we  have 
of  late  ;  but  we  are  reminded  o'  these  risks  in 
a  note  from  Professor  Billroth's  clinic  in  the 
Allgemeine  Wiener  Med.  Zeitung  for  Dec.  20th. 
The  writer  says  that  Professor  Billroth  has 
become  convinced  of  the  inutility  of  injections 
for  the  purpose  of  washing  out  the  empyemic 
cavity,  except  in  the  case  of  blood-clots  and 
decomposing  secretion ;  and  in  the  latter  case 
it  suffices  to  perform  a  single  but  thorough 
injection.  Thus  in  one  case  of  a  shot-wound 
in  the  left  thorax,  leading  to  purid  empyema, 
Professor  Bilroth  made  a  counter-opening,  and 
for  four  days  allowed  thymol  to  flow  through. 
In  ordinary  empyema  the  chances  are  favorable 
when  the  operation  is  done  at  the  right  time, 
for  the  longer  pus  remains  in  the  thorax  the 
longer  the  lung  keeps  atelectatic,  and  thus  does 
not  approach  the  wall  of  the  thorax.  A  rib  is 
resected,  a  drainage  tube  introduced,  and  pus 
allowed  free  escape — a  method  of  treatment 
much  like  that  practised  by  Hippocrates,  who 
bored  through  the  rib  and  introduced  a  short 
smooth  metal  tube  into  the  opening.  To 
diminish  pus  formation  a  rod  of  iodoform  can 
be  placed  in  the  pus  cavity.  Injections  of  cold 
disinfecting  fluids  often  lead  to  ill  consequences. 
Professor  Bilroth  relates  one — a  female,  twenty 
years  old,  with  empyema,  who  was  treated  by 
means  of  injections.  One  day,  when  »  cure 
was  nearly  accomplished,  she  became  uncon- 
scious during  the  injection,  and  could  not  be 
restored.  Dr.  Wolfler  also  had  an  older  patient 
who  became  unconscious  during  the  injection, 
but    who    recovered,     Billroth   explains    these 


remarkable  phenomena,  that  a  shock  is  received 
by  the  organism,  excited  through  the  peripheral 
nerves  by  means  of  cold  water,  and  under  ever 
so  slight  conditions,  it  may  be  the  cause  of 
death  ;  just  as  a  mere  blow  on  the  testicle  or 
stomach  region  can  be  fatal.  Therefore  it  is 
important  to  employ  injections,  when  they 
appear  necessary,  of  warm  fluid.  —  London 
Lancet. 


The  Rapidity  of  Absorption  from  Wounds. 
— Some  observations  on  the  rapidity  of  absorp- 
tion from  wounds  have  been  communicated  by 
M.  Davaine  to  the  Academie  des  Sciences. 
The  question  is  one  of  great  practical  import- 
ance,, since  a  virus  so  often  enters  the  system 
by  this  means.  That  absorption  from  a  sub- 
cutaneous wound  is  extremely  rapid  has  been 
demonstrated,  the  Gazette  Medicate  Teimndi^  us* 
by  the  experiments  of  Renault  on  the  poison 
of  glanders,  and  by  those  of  Colin  on  that  of 
anthrax.  A  few  minutes  were  found  to  be 
sufficient,  so  that  cauterization  was  u.seless  if  it 
was  performed  more  thari  ten  or  fifteen  minutes 
after  the  inoculation.  The  investigation  of 
Davaine  related  to  the  important  question 
whether  absorption  is  equally  rapid  from  the 
surface  of  all  wounds,  and  he  concludes  that  it 
is  not.  Having  placed  material  from  a  case  of 
anthrax  on  the  surface  of  wounds  produced  in 
rabbits  by  vesicants,  friction  with  rough  sur- 
faces, or  the  removal  of  a  small  piece  of  skin, 
he  found  that  many  animals  survived  when  the 
wound  was  cauterized  with  potassa  fusa  one, 
two,  or  three  hours  afterwards.  He  suggests 
an  anatomical  explanation  of  the  difierence  in 
the  experimental  results.  In  a  sub-epidermic 
wound  a  number  of  small  vessels  are  divided 
and  the  circulation  is  maintained  by  the 
collateral  branches  which  are  givt  n  off"  imme- 
diately below  the  divided  vessel,  and  by  this 
the  poison,  which  has  penetrated  into  the 
interior  of  a  divided  vessel,  is  carried  into  the 
general  circulation.  ,  The  same  effect  is  not 
produced  in  a  more  extensive  wound,  probably 
because  most  of  the  vascular  trunks  are  divided. 
Wtiatever  be  the  explanation,  it  is  clear  that 
punctured  wounds  are  by  far  the  most  danger- 
ous, and  that  cauteiization  to  be  effective 
should  be  very  prompt. — London  Lancet. 


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TREATMENT  OF  BOILS. 

Dr.  Lowenberg  finds  incisions  and  boracic 
acid  solution  the  most  effective  treatment  of 
boils.  Holding  that  they  are  produced  by  a 
microphytic  parasite,  he  rejects  the  usual 
emollient  treatment.  He  commences  by  in- 
cising them,  after  the  application  of  ether 
spray,  and  then  foments  with  a  saturated 
aqueous  or  alcoholic  solution  of  boracic  acid. 
When  the  boils  are  recent,  and  the  patients 
refuse  the  permission  to  incise  them,  he  finds 
that  simple  fomentations  with  boracic  acid 
solution  arrests  the  development  of  the  inflam- 
matory process. 

It  may  be  added  that  certain  internal 
remedies  possess  a  high  degree  of  value  in  a 
succession  of  boils,  notably  the  pyrophosphate 
of  soda,  and  the  hypophosphites.  The  relation 
of  a  succession  of  boils  to  a  saccharine  con- 
dition of  the  urine  should  not  be  overlooked. 
This  is  an  unknown  cause  sometimes  of  their 
persistence  in  spite  of  all  the  usual  remedies. — 
Medical  News. 


Swain  on  the  Application  or  the  Poro- 
PLASTic  Jacket  in  Spinal  Curvature. — This 
pamphlet  contains  a  useful  account  of  the 
method  of  applying  Cocking's  poroplastic 
jackets.  It  informs  us  that  "  his "  (Mr. 
Cocking's)  "attention  was  drawn  to  Prof. 
Say  re's  plaster-of-Paris  jackets,  and  he  con- 
ceived the  idea  that  his  poroplastic  felt  might 
be  used  for  the  purpose  of  forming  spinal 
supports,  having  this  great  advantage  over  the 
plaster-of-Paris  jacket,  viz.,  that  of  being 
easily  removed  from  the  patient,  and  re- 
applied." [As  a  matter  of  fact,  the  plaster-of- 
Paris  can  be  removed  and  re-applied  quite 
as  often  as  is  good  for  the  patient,  and  with 
perfect  ease,  provided  only  that  use  be  made  of 
the  system  of  triple-lacing,  long  ago  introduced 
by  the  reporter  into  Mr.  Marsh's  out-patient 
department  at  St.  Bartholomew's  Hospital, — 
Rep.\  Further  on,  the  author  tells  us  that 
"  herein  is  the  special  advantage  of  this  method 
of  spinal^support,  that  its  use  does  not  preclude 
the  further  use  of  other  curative  methods.  I 
allude  especially  to  extension  by  suspension 
find  gymnastic  exercises."     [This  is  an  assump 


tion  which  has  been  made  by  other  surgeons 
besides  Mr.  Swain,  but  which  can  only  be 
based  on  defective  knowledge  of  what  is  con- 
sistent with  Sayre's  plaster-of-Paris  jacket. 
The  plaster  jacket  can  easily  bo  removed, 
and  both  suspension  and  gymnastic  exercises 
can  be  freely  used  without  removing  it  at 
all. — Rep.  By  far  the  greater  part  of  Mr. 
Swain's  pamphlet  consists  of  practical  direc- 
tions and  warnings  regarding  the  use  of  the 
poroplastic  apparatus.  Measurements  are  to 
be  taken  at  the  axilla,  the  waist,  the  pelvis, 
and  from  the  axilla  to  the  great  trochanter,  as 
well  as  accurate  notes  of  the  position  of  the 
curve,  especially  if  angular,  and  of  such  bony 
processes  as  the  anterior  superior  spine  of  the 
ilium.  The  upper  and  lower  borders  and  the 
area  over  the  breasts,  are  to  be  left  soft.  The 
patient  is  prepared  much  as  for  the  application 
of  the  plaster  corset,  but  with  two  jerseys,  and 
without  cotton-wool  pads.  Instead  of  a  collar 
for  suspension,  a  broad  piece  of  soft  felt  is 
used  beneath  the  chin,  with  a  felt  strap  and 
a  buckle  passed  round  the  back  of  the  head. 
"  Care  should  he  taken  not  to  double  up 
the  ears  under  the  strap,  and  I  find  that  a 
little  cotton-wool  here  and  there  adds  to  the 
comfort."  When  a  jury-mast  is  used,  care 
must  be  taken  "  that  the  iron  rod  of  the  jury- 
mast  does  not  take  a  too  prominent  anterior 
curve  just  above  the  jacket.  If  this  be  the 
case  it  will  press  on  the  occiput,  and  very  soon 
cause  a  troublesome  sore."  In  the  absence  of  a 
proper  steam-bath,  the  kitchen  oven,  with  a  crock 
of  boiling  water  in  it,  may  be  used  to  soften 
the  jacket.  If  the  oven  be  used,  a  little  water 
should  also  be  sprinkled  over  the  jacket 
The  temperature  should  be  about  170  degrees 
to  180  degrees.  "Although  the  felt  very  soon 
becomes  soft,  it  does  not  become  thoroughly 
plastic  for  some  little  time."  Two  persons 
are  required  to  fit  the  jacket  well.  "  The 
surgeon  should  take  charge  of  the  back." 
"  The  middle  buckle,  which  will  be  generally 
found  to  tighten  the  jacket  round  the  waist,  is 
the  first  and  most  important  one  to  secure.' 
"  The  pelvic  buckles  should  be  the  next  closed, 
and,  lastly,  the  thoracic  ones,"  "  During  all 
this  time  the  surgeon  is  moulding  the  jacket 
to   the    form    posteriorly."     The    author  has 


OF  MEDICAL  SCIENCE. 


56 


"  found,  after  some  practice,  that  the  best  way 
to  accomplish  this  is  to  encircle  the  patient 
with  an  arm,  placing  one  hand  in  front  as 
an  opposing  force,  whilst  with  the  other  hand 
you  knead  the  material  into  the  figure,  using 
principally  the  ball  of  the  thumb."  "I  have 
found  that  a  slight  knock  on  the  jacket  with 
the  knuckles  tells  me  if  it  is  *  well  home.' " 
''  To  insure  a  perfect  fit  at  the  waist,  the 
assistant  encircles  the  jacket  at  that  point  with 
a  strap  of  soft  felt,  by  which  he  is  able  forcibly 
to  squeeze  it  into  the  figure."  The  patient 
must  be  kept  perfectly  still  for  half  an  hour 
after  the  application,  in  order  to  let  the  jacket 
become  quite  firm.  The  after-treatment  is  of 
great  importance.  This  involves  frequent  re- 
moval of  the  jacket  for  exercise.  It  should 
always  be  re-applied  during  suspension.  Daily 
suspension  is  used.  For  some  time,  the  jacket 
is  worn  night  and  day.  From  time  to  time 
the  jacket  should  be  re-moulded. — London 
Medical  Record. 


Morton  on  Club-Foot. — At  a  meeting  of 
the  Philadelphia  Academy  of  Surgery  {Phila. 
Med.  Times,  June  29,  1881),  Dr.  Morton 
exhibited  some  cases  of  club-foot  treated,  from 
soon  after  birth,  by  manipulation  and  "  the 
wearing  of  proper  shoes,"  without  tenotomy. 
The  results  were  good.  In  cases  seen  in 
infancy  he  attempted,  and  was  usually  able, 
to  cure  the  talipes  without  tenotomy,  except 
in  some  instances  of  talipes  equinus.  When 
he  was  obliged  to  divide  the  tendo  Achillis,  he 
did  not  do  it  until  the  child  began  to  walk. 
In  the  discussion  which  followed,  Dr.  S.  W. 
Gross  thought  the  ordinary  method  of  oppra- 
ting  useless,  and  the  usual  method  of  applying 
the  shoe,  a  barbarity;  still  he  believed  that 
division  of  the  tendo  Achillis  was  preferable, 
because  it  hastened  cure.  The  varus  should 
be  overcome  by  manipulation  first,  and  the 
heel  then  brought  down.  After  manipula- 
tion had  been  begun,  the  foot  may  be  kept 
in  place  by  adhesive  plaster  carried  around  the 
foot  and  up  the  leg.  Dr.  D.  Hayes  Agnew 
considered  no  operation  wise  at  an  earlier  age 
than  one  year,  but  in  the  meantime  it  was  well 
to  correct  deformity  and  develop  the  paralysed 
muscles  by  manipulation. — London  Medical 
Record, 


A  Modification  of  Lister's  Antiseptic 
Dressing. — In  the  New  York  Medical  Journal 
and  Obstetrical  Review  for  December,  1881, 
Dr.  James  L.  Little,  Professor  of  Clinical 
Surgery  in  the  University  of  the  City  of  New 
York,  says,  that  he  has  for  the  past  six  years, 
been  using  the  following  antiseptic  dressing : — 
Having  put  the  parts  in  a  condition  for  drr^ss- 
ing,  he  washes  the  wound  in  a  solution  of 
carbolic  acid  of  the  strength  of  one  to  twenty  ; 
he  then  covers  the  parts  with  a  thick  layer  of 
borated  cotton,  and  then  snugly  and  evenly 
applies  a  simple  gauze  bandage.  At  first  he 
used  bandages  made  of  antiseptic  gauze,  but 
for  the  past  three  years  has  used  those  of  plain 
uncarbolized  cheese  cloth.  These  thin  ban- 
dages distribute  the  pressure  more  evenly 
over  the  cotton,  and  are  more  easily  saturated 
with  fluids  than  those  made  of  unbleached 
muslin.  The  patient  is  instructed  to  keep  the 
outside  of  the  dressing  wet  with  a  solution  of 
carbolic  acid,  which  is  of  the  strength  of  one  to 
one  hundred.  The  author  employs  Squibb's 
solution  of  pure  carbolic  acid,  which  is  of  the 
strength  of  one  to  fifty,  and  which,  when 
mixed  with  an  equal  bulk  of  water,  gives  a 
solution  of  the  desired  strength.  The  parts 
should  be  at  rest,  and  the  dressings  may  be 
left  undisturbed  for  several  days,  imless  there 
is  pain,  rise  of  temperature,  or  discharge 
through  the  dressings.  Thes«  conditions  are 
always  to  be  considered  indications  for  re- 
newing the  dressings.  To  ensure  success  in 
cases  where  the  dressing  is  used,  full  precau- 
tions as  to  rendering  the  instruments,  sponges, 
and  the  hands  of  the  surgeon  aseptic,  and  the 
use  of  drainage-tubes  if  necessary,  should  not 
be  neglected.  Catgut  or  torsion  should  be 
used  to  arrest  haemorrhage.  The  spray  may  be 
resorted  to,  if  thought  necessary.  At  the 
second  dressing  the  author  now  usually  applies 
carbolized  oil,  of  the  strength  of  one  to  twelve, 
to  the  wound  to  facilitate  the  removal  of  the 
cotton,  which  is  otherwise  apt  to  adhere  after 
the  first  dressing. — Michigan  Medical  News. 


A  New  Complication  of  Lithotomy. — Dur- 
ing a  recent  clinical  lecture.  Dr.  Agnew  {Medi- 
cal News,  January  7th,  1881),  who  was  about 
to  perform    lithotomy,    called  attention  to   a 


56 


CANADIAN  JOURNAL 


temporary  condition  which  necessitated  delay. 
Etherization  was  complete,  but  the  respiratory 
movements  were  hurried  and  excessive ;  the 
sphincters  of  the  anus  were  entirely  relaxed, 
and  the  anal  aperture  was  patulous,  an  inch 
and  a  half  or  two  inches  in  diameter,  and  mov- 
ing in  sympathy  with  the  expansion  and  con- 
traction of  the  thorax.  It  this  manner  it 
seemed  to  act  as  a  valve,  admitting  air  to  the 
rectum,  but  not  favouring  its  expulsion,  so  that 
for  several  minutes  the  lower  bowel  was  in  a 
state  of  distention.  There  would  have  been 
groat  danger  of  wounding  it  had  the  operation 
been  proceeded  with  under  these  circumstances. 
In  a  short  time  as  deeper  anaesthesia  was  pro- 
duced, the  anus  resumed  its  normal  appearance, 
and  tie  rectal  dilatation  disapp'  ared.  So  far 
this  possible  complication  of  lithotomy  has  not 
been   alluded   to   hitherto.  —  Chicago   Medical 

Review. 

■  ■»■ « 

Illingwortu  on  Manipulation  in  Reduc- 
tion OF  Dislocated  Humerus. — Mr.  Illing. 
worth,  in  the  British  MedicalJournal,  October, 
1881,  p.  626,  reports  two  cases  in  which  dislo- 
cation of  the  humerus  into  the  axilla  was 
readily  reduced  by  the  following  method. 
"  The  arm  being  abducted  and  extended  with 
slight  force  by  an  assistant,  I  firmly  grasped 
the  scapula  with  the  right  hand  over  the 
acromion,  and  depressed  it  in  such  a  manner 
as  to  make  the  lower  edge  of  the  glenoid  cavity 
slide  over  the  rounded  head  of  the  humerus, 
whilst  with  the  fingers  of  the  left  hand  I 
exerted  gentle  ()res8uro  upwards  on  the  shaft 
of  the  humerus,  just  below  the  hea-1.  Re. 
duction  was  in  each  case  immt*diate." — London 
Medical  Record. 


Fiddle-String  as  a  Bougie. — Dr.  F  E. 
Daniel,  of  Jackson,  Mids.,  failinj^  in  a  case  of 
very  tight  stricture  to  get  in  the  smallest 
ordinary  bougie,  used  in  the  emergencv  a 
small  Ji< Idle-string.  This  pissed  in  readily. 
Being  withdrawn  in  a  few  minutes,  it  was 
found  to  have  swoUi-n  to  nearly  twice  its 
revious  size.  A  larger  one  wuh  then  passed 
and  allowed  to  remain  tifteen  minutes  ;  this 
being  then  withdrawn,  the  urethra  was 
sufficiently  dilated  to  g<  t  in  a  No.  4,  then  a 


No.  6  bougie,  and  finally  a  flexible  Nelaton's 
catheter,  threaded  on  a  fiddle-string.  A  second 
case  was  equally  satisfactory.  Dr.  D.  claims 
for  the  fiddle-string  (catgut)  cheapness,  sim- 
plicity, availability,  harmlessness,  strength,  and 
rapid  expansion. — Maryland  Medical  Journal) 
Dec,  1,  1881. — Medical  News. 


pidwiferu. 


CLINICAL    LECTURE   ON    URETHRAL 
CARUNCLE. 

Delivered  at  the  Hospital  of  the  University  of  Pennsylvania, 
June  8, 1881. 

BY   WILLIAM    GOODELL,    M.D. 

Professor  of  Clinical  Gynae  ology. 

Reported  by  Guy  Hinsdale,  M.D. 

Gentlemen, — This  patient,  a  woman  forty 
years  of  age,  complains  of  great  pain  when 
passing  her  water.  For  several  months  her 
urine  has  scalded  her;  but  the  pain  is  con- 
stantly growing  worse,  and  is  now  almost  un- 
bearable. It  is  most  intense  as  the  last  few 
drops  come  away.  Inasmuch  as  most  of  the 
lesions  of  the  reproductive  apparatus — such  as 
vaginitis,  uterine  displacements,  etc. — give  rise 
to  vesical  disturbancf>,  and  since  the  symptoms 
are  not  always  typical,  a  urethral  caruncle  is 
very  likely  to  be  overlooked  by  the  physician. 
Reflex  symptoms,  uterine  in  their  expression, 
lead  him  astray,  while  a  very  natural  delicacy 
prevents  him  from  making  the  needful  visual 
inspection  of  the  parts  Ind- ed,  you  cannot 
say  in  these  cases,  '•  I  will  look  at  the  parts  and 
see  what  is  the  matter."  Woman's  modest 
nature — we  would  not  have  it  otherwise — in- 
stinctively resents  such  an  examination,  and,  if 
brusquely  proposed,  it  will  almost  always  be 
denied.  What,  then,  can  you  dol  You  can 
do  it  without  consulting  her.  You  can  ask  for 
a  vaginal  examination, — to  which  most  women 
will  submit, — and  while  you  are  exploi-iug  the 
uterus  with  the  index  finger  you  may  with  the 
thumb  press  upon  the  meatus,  and  notice 
whether  the  contact  elicits  pain  ;  then,  as  you 
introduce  or  as  you  remove  the  speculum,  with 
your  eye  glance  at  the  urethra.  It  has  always 
been  my  experience  that  whenever  you  can 
confidently  say  to  your  patient,  "  I  have  dis- 


OF  MEDICAL  SCIENCE. 


57 


covered  the  cause  of  your  trouble ;  here  it  is," 
— and  then  by  pressing  upon  the  caruncle  con- 
vince her  that  jour  statement  is  correct, — she 
will  not  refuse  any  future  needful  exposure  of 
her  person.  I  make  it  an  inflexible  rule,  when 
a  woman  complains  of  pain  in  passing  her 
water,  to  feel  for  a  caruncle.  You  must  not 
forget  in  all  these  cases  to  go  through  with  the 
formality  of  covering  the  patient  with  a  sheet; 
for  just  as  you  gild  and  sugar-coat  what  is 
bitter  to  the  taste,  so  you  must  gild  and  sugar 
coat  what  is  bitter  to  the  mind. 

As  I  separate  her  thighs  and  expose  the 
meatus  urinarius,  those  of  you  who  are  near 
can  see  at  the  upper  margin  of  the  meatus  a 
small  crimson  and  wart-like  body.  It  is  a 
vascular  excrescence  of  the  urethra,  and  looks 
like  a  small  Antwerp  raspberry.  Notice  its 
vascularity:  'it  bleeds  on  the  slightest  touch. 
Observe  how  sen.sitive  it  is :  although  pro- 
foundly etherized,  the  woman  winces  and  draws 
up  her  limbs.  So  exquisitely  alert  are  the 
little  nervelets  distributed  over  its  surface  that 
were  she  not  under  the  influence  of  ether  she 
would  writhe  with  pain  under  even  the  gentlest 
touch.  The  vulva  and  outlying  organs  of  a 
woman  are,  as  you  have  often  observed  in  this 
amphitheatre,  the  last  to  yield  to  the  influence 
of  the  anaesthetic.  Sensation  here  is  so  acute 
that  it  will  remain  long  after  other  peripheral 
nerves  have  become  benumbed. 

This  little  growth  seems  insignificant,  but  it 
has  given  this  woman  an  immense  amount  of 
suff'ering.  Not  only  does  she  have  pain  during 
micturition,  but  even  in  walking  she  is  com- 
pelled to  straddle  her  legs  to  avoid  irritation. 
Some  of  the  more  aggravated  cases  that  have 
come  to  my  notice  have  presented  a  train  of 
symptoms  that  could  hardly  be  supposed  to 
be  directly  caused  by  such  a  little  growth. 
There  may  be  constant  heat  and  throbbing  of 
the  external  organs  of  generation,  with  more 
or  less  of  leucorrhoea,  and  the  linen  may  be 
often  stained  with  blood,  and  the  urine  streaked 
with  it.  Cohabitation  becomes  painful,  pro- 
ducing the  condition  known  as  djspareunia. 
It  is  at  the  first  entrance  of  the  male  organ 
that  there  is  the  most  pain.  This  is  so  in- 
tolerable that  many  women  will  not  permit 
their  husbands  to  approach  them.     This  is,  of 


course,  a  source  of  domestic  uuhappiness.  By 
brooding  over  their  sufferings  and  their  incom- 
plete conjugal  relations  the  mind  becomes 
morbid,  and  in  some  cases  women  have  been 
driven  to  insanity  or  even  suicide. 

These  torturing  growths  are  more  common 
to  the  married  than  to  the  single,  and  occur 
usually  in  women  who  have  passed  the  prime 
of  life.  I  am  inclined  to  think  that  they  owe 
their  existence  to  the  congestion  of  the  urethral 
plexus  of  veins,  such,  for  instance,  as  is  induced 
by  the  pressure  of  the  gravid  or  displaced  womb, 
or  by  that  of  ati  over-distended  bladder  or  of  a 
loaded  rectum.  In  fact,  pretty  much  the  same 
causes  are  at  work  which  tend  to  produce  piles. 
Thev  consist  of  hypertrophied  papillae  covered 
with  a  layer  of  tessellated  epithelium,  and  are 
largely  supplied  with  nerves  and  blood-vessels. 

Now  comes  the  final  question.  What  can 
we  do  to  effect  a  cure  1  When  there  is  a  dis- 
tinct pedicle,  one  snip  of  the  scissors  is  all  that 
is  needed ;  but  when,  as  in  this  case,  they  are 
attached  by  a  broad  base,  difficulties  arise  which 
demand  ether  and  assistance.  The  patient  lies 
back,  her  knees  being  supported  by  these 
gentlemen,  who  also  place  their  fingers  on  each 
side  of  the  meatus  and  stretch  it  open.  Catch- 
ing the  caruncle  with  a  tenaculum,  I  raise  it 
up  and  dissect  it  but,  taking  with  it  some  of 
the  sound  flesh.  The  svound  bleeds  freely.  In 
order  to  check  the  hemorrhage,  and  to  insure 
the  complete  destruction  of  the  growth,  we 
shall  now  cauterize  it.  T  shall  cauterize  it  as 
you  would  have  to  do  in  the  country,  and  I 
shall  not,  therefore,  employ  on  this  occasion 
the  Paquelin  thermo-cautery,  which,  although 
it  is  by  far  the  best  and  most  convenient  in- 
strument for  the  purpose,  is  so  expensive  that 
few  of  you  will  be  able  to  command  it.  You 
can  therefore  use  the  iron  handle  of  a  broken 
file  heated  to  redness,  as  you  now  see  me  heat 
it,  taking  care,  however,  that  your  eyes  are 
not  exposed  to  any  bright  flame  as  the  instru- 
ment is  being  heated,  for  the  light  may  dazzle 
you,  and  a  large  black  spot  will  follow  and 
obscure  your  vision,  no  matter  where  you  look. 
The  pale  flame  of  an  alcohol  lamp  is,  therefore, 
the  best  for  the  purpose. 

Nitric  acid  is  not  so  efficient  a  caustic  as  the 
hot   iron.      Formerly   I   always   employed    it. 


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CANADIAN  JOURNAL 


seariug  the  raw  surface  of  the  wound  with  the 
frayed  end  of  a  match  dipi)ed  into  the  fuming 
acid.  It  does  not,  however,  always  stay  the 
hemorrhage,  which  is  sometimes  quite  free.  I 
shall  never  forget  a  scrape  I  got  into  some  time 
ago,  while  doing  an  operation  of  this  kind. 
The  patient  was  a  very  nice  lady,  but  she  was 
exceedingly  reluctant  to  my  having  any  other 
gentlemen  present  at  the  operation.  Her 
sisters  stoutly  protested  their  ability  to  give 
the  assistance  that  1  said  was  needed,  and 
begged  me  to  rely  upon  them  instead  of  calling 
in  any  outside  aid.  This  I  finally  consented  to 
do.  Everything  progressed  nicely  until  I  began 
to  dissect  out  the  growth,  when,  suddenly  no- 
ticing one  of  the  patient's  legs  beginning  to 
grow  unsteady,  I  looked  up  and  caught  sight 
of  one  of  the  sisters  going  off  in  a  fainting-fit. 
I  instantly  turned  upon  her  and  shouted, 
"  Stop  that !  If  you  faint,  I'll  stick  a  pin  into 
you  ! "  This  brought  her  to  her  senses,  and 
sent  a  flush  of  blood  to  her  cheeks.  By  mak- 
ing a  vigorous  use  of  threats,  and  by  constantly 
talking  to  her,  I  managed  to  keep  her  on  her 
feet.  Towards  the  end,  however,  she  could  not 
stand  it  any  longer,  and  while  I  was  applying 
the  nitric  acid  she  suddenly  fell  to  the  floor. 
In  the  confusion  and  excitement  of  the  mo- 
ment I  unluckily  upset  the  bottle  of  nitric 
acid  over  the  handsome  Brussels  carpet.  .  But 
this  was  not  all.  At  my  second  visit,  twelve 
hours  afterwards,  I  found  that  the  lady  had 
lost  and  was  still  losing  too  much  blood.  I 
stanched  the  bleeding  point  with  ice  and 
Monsel's  salt,  and  put  on  a  compress  with  a  T 
bandage  ;  but  at  my  next  visit,  six  houi-s  later, 
I  found  her  quite  blanched  from  a  recurrence 
of  the  hemorrhage.  I  now  appl'ed  the  solid 
stick  of  silver  nitrate,  but  without  avail  ;  then 
I  tried  to  nip  the  bleeding  point  with  a  serre- 
fine,  but  the  tenderness  of  the  part  was  so  great 
that  she  would  not  permit  any  further  inter- 
ference, nor  would  she  again  inhctle  an  ansea- 
tbetic.  For  a  moment  I  was  at  my  wits'  end 
to  know  what  to  do.  The  prospect  of  spending 
the  day  at  her  bedside;  with  my  fing»^r  pressing 
on  the  uieihra,  through  the  vagina,  was  not 
an  agreeable  one;  but  I  finally  succeeded  by 
stufiing  a  sponge  half-way  into  the  vulvar 
oi>ening.      Its  elasticity,  and  that  of   the  per- 


ineum, on  which  it  rested,  made  the  needful 
pressure  on  the  bleeding  surface. 

The  after-treatment  will  consist  of  the  appli- 
cation, twice  a  week,  of  the  undiluted  commer- 
cial carbolic  acid  until  the  raw  surface  has 
skinned  over.  If  you  follow  the  plan  of  treat- 
ment that  I  have  laid  down  you  will  rarely 
have  to  repeat  the  operation.  Although  I  have 
often  burnt  these  caruncles,  there  has  never 
followed  any  contraction  of  the  urethra:  mucous 
membrane  does  not  undergo  the  cicatricial 
contraction  that  skin  does. 

Gentlemen,  once  in  a  while,  in  treating  a 
woman  for  another  disease,  you  will  come 
across  a  caruncle,  and  you  may  be  tempted  to 
remove  it ;  but  let  well  enough  alone,  and  do 
not  touch  it,  unless  you  know  it  to  be  of  the 
painful  kind.  The  suffering  caused  by  them 
bears  no  relation  whatever  to  their  size,  and, 
unless  the  symptoms  are  aggravated,  it  is  best 
not  to  touch  them. — Philadelphia  Medical 
Times. 


UTERINE  DISPLACEMENTS. 

Dr.  Paul  F.  Munde  gives  the  following 
resume  of  his  valuable  paper  on  the  treatment 
of  uterine  displacements  : — 

1.  Recent  displacements  of  any  variety  are 
the  only  cases  which  offer  a  fair  chance  of 
complete  recovery  by  any  of  the  mechanical 
means  at  our  disposal. 

2.  Of  these  means,  pessaries  are  the  most 
convenient  for  temporary  relief,  but  only  in  a 
comparatively  small  number  of  cases  does  per- 
manent cure  i-esult. 

.3.  The  best  curative  means  of  support  of  the 
displaced  uterus  is  probably  the  systematic  and 
intelligent  use  of  vaginal  tampons,  impregnated 
with  a  mild  astringent  solution. 

4.  Posture,  while  excellent  as  a  means  of 
relaxing  the  uterine  supports  and  relieving 
pelvic  congestion,  is  by  its  inconvenience  at 
best  but  a  means  of  temporary  relief. 

5.  Permanent  relief,  cure,  can  be  expected 
and  will  be  obtained  only  when  the  disjlace- 
raent  is  of  recent  origin,  especially  when  it  has 
been  produced  by  some  sudden  shock  ;  or  when 
the  complete  tissue-metamorphosis  accompany- 
ing puerperal   involution   aids   in  restoring  to 


OF  MEDICAL  SCIENCE. 


59 


the  uterine  supports  and  the  uterus  itself  their 
original  and  healthy  tone. 

This  fortunate  occurrence  must  be  looked 
upon  as  decidedly  the  exception,  since  the 
favoring  circumstances  above  mentioned  are 
but  rarely  met  with  or  the  displacement  is 
seldom  recognized  at  a  sufficiently  early  date  to 
permit  of  a  perfect  restoration  to  health. 

6.  The  most  favorable  period,  therefore,  for 
the  treatment  of  a  uterine  displacement  or  dis- 
tortion with  the  view  to  a  permanent  cure  is 
within  one  or  two  weeks  after  delivery,  before 
the  woman  has  left  her  bed. 

7.  The  excitation  of  a  certain  amount  of 
plastic  exudation  in  the  walls  of  a  fixed  uterus 
may,  if  kept  within  bounds,  result  in  permanent 
straightening  of  the  organ.  This  may  be 
accomplished  by  rapid  dilatation,  or  by  the 
protracted  wearing  of  stem-pessaries,  but  per- 
manent success  will  at  best  be  rare. 

8.  The  protracted  wearing  of  astringent 
vaginal  tampons,  introduced  daily,  ofiers  for 
some  cases  of  ante-  and  retro-displacement  an 
excellent,  and  for  most  cases  of  procidentia, 
almost  the  only  efficient  and  safe  remedy  for  the 
displacement,  far  superior  to  all  steadily-worn 
hard  or  soft  pessaries.  A  procidentia  of  uterus 
or  vagina  may  even  be  cured  by  several  months 
of  this  treatment,  if  the  affection  be  not  of  too 
long  standing. 

9.  While  permanent  cure  is  only  occasionally 
met  with,  so  much  relief  is  afforded  by  pessaries 
and  the  other  mechanical  supports  and  methods 
above  discussed  that  they  should  in  no  case  be 
discarded,  unless  all  treatment  be  counter- 
indicated. 

10.  Electricity,  if  rationally  and  scientifically 
applied  for  a  sufficiently  long  period,  offers 
chances  of  cure  of  comparatively  recent  cases, 
which  call  for  a  more  thorough  and  pei-sistent 
trial  of  the  method. 

11.  For  prolapsus  uteri  et  yaginae,  unless  of 
quite  recent  origin  (see  tampons),  an  operative 
constriction  of  the  vaginal  canal  and  a  restora- 
tion of  the  relaxed  or  destroyed  perineum  to  its 
normal  state  is  the  only  sure  means  of  cure, 
and  even  for  this  affection  the  unfailing  method 
remains  still  to  be  discovered. 

12.  The  cwre  of  a  flexion  by  operative  (bloody) 
treatment   is   impossible;    the   canal  may   be 


made  perfectly  straight  by  a  division  of  one  or 
the  other  or  both  lips  of  the  cervix,  but  the 
fixed  shape  of  the  organ  still  remains.  Only 
by  gradually  increasing  elevation  of  the  fundus 
by  a  vaginal  pessary  (best  Thomas'  cup),  after 
delivery,  or  by  the  protracted  wearing  of  an 
intra-uterine  stem,  can  in  a  small  proportion  of 
cases  a  permanent  cure  be  effected. — American 
Journal  0^  Obstetrics,  Oct.  1881. 


TRACHEOTOMY  IN  DIPHTHERIA- 
RECOVERY. 

Dr.  W.  T.  Lusk  said  that  in  the  early  part 
of  last  spring  he  was  summoned  to  see  a  child, 
a  patient  of  Dr.  O'Neil's,  who  was  said  to  have 
croup.  He  was  unable  to  visit  the  patient 
until  after  the  lapse  of  an  hour.  He  then  did 
so,  taking  the  instruments  necessary  for  the 
performance  of  tracheotomy  with  him.  When 
he  entered  the  house,  Dr.  O'Neil  said  to  him, 
"  It  is  too  late ;  the  child  is  gone."  He  went 
in  and  found  a  child  eight  years  old  lying  on 
its  mother's  lap,  completely  cyanosed,  with 
pupils  widely  dilated,  in  an  unconscious  state, 
and  breathing  at  long  intervals.  It  was  evi- 
dent that  only  one  thing  remained  to  be  done 
under  the  circumstances,  and  that  was  trache- 
otomy. Dr.  O'Neil  expreseed  gi'eat  doubt  as 
to  the  operation  affording  any  hope,  adding 
that  he  had  witnessed  a  number  of  operations, 
but  that  in  every  one  the  patient  had  died,  and 
that,  so  far  as  he  was  concerned,  he  was  opposed 
to  torturing  the  child  at  this  time.  Dr.  Lusk 
replied  that  when  the  child  died  it  was  not 
from  the  operation,  but  from  extension  of  the 
disease  j  and  that  this  child,  being  eight  or 
nine  years  old,  stood  a  chance  of  recovering. 
On  questioning  the  doctor,  he  learned  that  the 
child  had  had  diphtheria  a  week,  but  that  the 
symptoms  of  croup  and  asphyxia  had  come  on 
very  suddenly  that  morning.  It  was  decided 
to  leave  the  question  of  tracheotomj  to  the 
mother,  who  had  expressed  herself  very  strongly 
against  it  before  Dr.  Lusk's  arrival.  On  being 
assured  by  Dr.  Lusk  that  he  had  known 
recovery  to  follow  the  operation,  she  consented 
to  it,  however.  He  took  the  child  and  went 
into  another  room,  and  as  rapidly  as  possible 
opened  the  trachea  and  inserted  the  tube.    The 


60 


CANADIAN  JOURNAL 


child  was  so  cyanosed,  and   the  intervals  be- 
tween the  respirations  were  so  long,  that  he 
feai*ed  it  would  die  during  the  operation  ;    but 
as  soon  as  the  tube  was  introduced  the  child 
gave   a    strong    expiration,    and    membranes, 
mucus,  and  blood  spurted  out  full  two  feet  from 
the  0[)euing.     In  a  few   moments    the   colour 
began  to  return  to  the  face,  and  in  tliree  or 
four  minutes  the  child  put  its  hand  up  to  its 
throat,  showing  that  sensation  was  beginning 
to  return,  and  opened  its  eyes ;  the  pujjils  con- 
tracted again,  and  in  ten  minutes  the  cyanosis 
had  dispppeared  and  the  child  looked  perfectly 
natural.     The  tube  was  allowed  to  remain  in 
the  throat  five  days ;  it  was  then  removed,  and 
the  child  made  a  perfect  recovery.      He  nai*- 
i-ated  this  case  to  give  encouragement  to  many 
in  this  city  who  had  a  great  repugnance  to  this 
operation.       tie   had   long  since   made  up  his 
mind  not  to  allow  a  child  to  die  from  asphyxia 
in  a  case  of  diphtheritic  croup.     He  asked  Dr. 
Jacobi  if  the  conditions  in  this  case  were  not 
rendered    favourable  by  the  age  of   the  child 
and  by  the  asphyxia  coming  on  suddenly,  not 
slowly.     Dr.  Jacobi  said  the  child  was  mani- 
festly dying,  and  of  suffocation,  and  that  was 
indication   enough  for  tracheotomy.      He  was 
very  glad  that,  while  ten  or  twenty  years  ago 
he  was  one  of  only  a  very  few  in  New   York 
who  favoured  the  operation,  to-day  there  were 
many  dozens  and  scores  of  physicians  who  were 
just  as  willing  to  perform  it  when  a  child  was 
suffocating  as  he  had  been  then  and  was  still. 
He  was  very  glad  to  have  heard  of  this  case, 
for  it  must  have  made  a  great  impression  upon 
the   family  physician,  upon    the    mother,  and 
upon  the  friends  of  the  family,  and  it  would 
certainly  do   a   great  deal    to    popularize  the 
operation.     If  only  one  of  a  number  of  opera- 
tions was  successful,  it  justified  our  resorting 
to    it   in    these    cases. — New     York    Medical 
Joumal. 


Laceration  of  Cervix  Uteri. — Dr.  Goodell 
thinks  that  the  most  common  cause  of  lacer- 
(uion  of  the  cervix  uteri  is  too  early  rupture 
of  the  membranes,  to  which  there  is  a  great 
temptation  to  resort,  as  it  undoubtedly  hurries 
the  labor  through  in  a  multipara.  As  a  rule, 
it  is  best  to  wait  until   the  os  is  dilated.      In 


performing  Emmet's  operation  he  prefers  the 

knife  to  the  scissora  for  denuding.     In  drawing 

the    uterus  down,  care    should  be  taken  not   to 

make  very  powerful  traction,  as  pelvic  cellulitis 

might  be  caused.       Of  one  hundred  and  twelve 

operations  done  by  himself,  only  two  have  been 

followed    by    inflammation — both    in    hospital 

practice.       Neither   was    fatal.     In    both     the 

inflammation  was  peritoneal,  and  in  one  it  was 

attributed  to   erysipelatous     contagion,    as     a 

patient    with  erysipelas  occupied  the  next  bed. 

He  never  operates  under  the  spray,  but  always 

bathes  the  parts  with  a  one-to-forty  solution  of 

carbolic   acid.       He  endeavors   to    remove    all 

cicatricial  tissue,  and  insei-ts  the  lower  sutures 

first,  as  they  ofler  the  greatest  difiiculty.     Other 

things  being  equal,  the  finer  the  wire  the  less 

likely  it  is  to  cut  out.      After  passing  each  stitch 

the    ends  ;ire  brought  together  and  a  shot   is 

slipped   over   them.       Secondary    haemorrhage 

happened  in  one  of  his   cases,  but  it  was  not  at 

all  alarming.     In  such  a  case  it  is  best  not    to 

tampon  the  vagina  if  it  can  be  avoided,  as  the 

accumulation  of  blood  would  interfere  with  the 

success  of  the  operation,  but  rather  inject  hot 

water,  followed,  if  necessary,  by  the  injection  of 

a  hot  solution  of  alum.      The  removal  of  the 

sutures  is  much  facilitated  by  not  cutting  short 

those  of  them  that  are  likely  tooffer  any  difficulty. 

To  prevent  the  wire  from  sticking  the    vagina, 

a    shot    is  clamped    on    its  end. — New     York 

Medical  Review. 


Prevention  of  Rupture  of  Perineum. — The 
latest  method,  that  ol  Dr.  Thad.  A.  Reamy,  of 
Cincinnati,  consists  in,  according  to  t\iQ  Medical 
News,  placing  th'j  patient  on  her  back  (the 
limbs  being  fl  xed  to  the  greatest  jjracticable 
degree)  and  stretching  smoothly  over  the  bulg- 
ing perineum  a  towel,  the  extremities  of  which 
are  held  beyond  the  gluteal  masses  on  either 
side  by  his  own  or  his  assistant's  hands.  The 
perineum  is  not  touched  except  by  the  towel, 
and  all  the  tension  is  made  trom  the  ends  of 
the  towfl  Applied  smoothly  in  this  manner, 
with  its  upper  border  on  a  level  with  the 
posterior  commissure,  and  the  posterior  border 
extending  to  a  point  opposite  the  coccyx,  the 
tow»l  forms  a  supj)lementary  perineum,  which, 
while  remaining  untorn,  effectually  prevents 
rupture  of  the  tissues  beneath.  It  should  not 
be  removed  until  after  the  shoulders  ioc  born. 


OF  MEDICAL  SCIENCE. 


61 


Dr.  Erich  relates  several  interesting  cases  of 
pelvic  abscess,  with  special  reference  to  the 
diagnosis  between  such  formations  and  solid 
abdominal  tumors.  So  great  are  the  dijOScultie** 
that  he  thinks  it  advisable  to  aspirate  in  all 
cases  of  doubtful  abdominal  tumor  before 
pronouncing  definitely  upon  its  nature.  After 
evacuating  a  pelvic  abscess  it  should  be  kept 
constantly  drained  with  a  syphon  drain,  and 
washed  out  daily  with  an  antiseptic  solution. — 
New  York  Medical  Review. 


(i>mxt^)iimUuu. 


To  the  Editor  of  the  Canadian  Jourhai.  of  Medical  Scusnck. 

Sir, — A  little  light  upon  a  couple  of  points, 
not  alluded  to  by  the  Dean  at  the  annual  dinner 
of  Trinity  Medical  College,  in  his  address  to  the 
students,  might  possibly  be  of  benefit,  not  only  to 
the  medical  students  but  to  the  Dean  him  self;  and 
in  the  hope  of  obtaining  light  I  venture  to  put 
the  following  questions  :  1.  In  Kingston,  where 
resides  "  one  examiner,  you  know  wJio,"  and 
who  the  Dean  and  his  supporters  say  is  "severe, 
dishonest,  unjust,  and  partial,"  why  is  it  that 
there  are  no  "  unseemly  squabbles "  between 
the  students  and  the  Council,  and  that  the 
former  are  always  satisfied  with  the  questions 
and  with  the  decisions  of  the  examiners?  2. 
In  Toronto,  where  resides  the  Dean,  who  is  so 
modest,  so  upright,  so  impartial,  so  peaceful,  so 
jealous  of  the  honour  of  the  profession,  always 
instilling  the  noblest  principles  into  the  minds 
of  the  students  of  his  University  School,  why 
is  it  that  these  "  unseemly  sqixabbles "  always 
occur,  and  that  the  students  always  feel  them- 
selves to  have  been  unjustly  treated  by  ttie 
examiners  %  3.  If  "  one  examiner,  you  know 
who,"  is  so  unjust  to  tiie  candidates  from  the 
schools  outside  of  Kingston,  how  is  it  that  as  a 
result  of  thfi  last  examination  so  much  com- 
plained of,  McGill  and  Toronto  School  of  Medi- 
cine obtained  so  much  larger  a  percentage  of 
success  than  his  own  school  ?  Of  the  candi- 
dates who  presented  for  examination  from  the 
Canadian  schools  there  were  passed  from : 
McGill  College,  in  round  numbers,  68  per  cent.; 
Toronto  School  of  Medicine,  45  per  cent.;  R.  C. 
of  Surgeons,  Kingston,  40  per  cent.;  Trinity 
Mo'iical  School,  22  per  cent.  These  figures  are 
startling  and  would  almost  justify  a  suspicion 
that  some  one  was  working  in  the  interest  of 
McGill  College  or  against  the  interest  of 
Trinity.  Who  was  if?  Was  it  the  examiner, 
"one  you  know;"  or,  was  it  the  Dean  1 
Yours,  etc, 

Medicus. 


THE  CANADIAN 


\nxm\  of  Ijdiciii  \ntm, 


A  Monthly  Jonrnal  of  Medical  Science,  Criticism, 
and  News. 


To  Correspondents. —  We  shall  be  glad  to  re- 
ceive from  our  friends  everywhere,  current  medical 
ttews  oj  s^en^al  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwarding  reports  of  the  proceedings  of  their 
Associations. 


TORONTO,  FEBRUARY,  1882. 

CONSULTATIONS  WITH    HOMCEO- 
PATHS. 

Since  Dr.  Bristowe  and  Mr.  Hutchinson,  at 
the  last  meeting  of  the  British  Medical  Asso- 
ciation, indiscreetly  raised  the  question  as  to 
whether  homoeopathy  were  not  really  fostered 
by  the  unanimous  ostracism  of  Hahnemann's 
disciples  by  the  general  body  medical  for  the 
past  eighty  years,  the  professional  mind  has 
been  disquieted  by  the  seeming  indications  of 
ethical  laxity  and  moral  obtuseness  obtaining 
a  foothold  in  high  places.  The  action  of  the 
Royal  College  of  Physicians  at  an  extra- 
ordinary meeting  on  the  27th  December  last, 
under  the  presidency  of  the  ve.eran.  Sir 
William  Jenner,  K.C.B.,  (whose  uncompromis- 
ing probity  has  long  been  the  et  pro&sidium  et 
dulce  decus  of  our  cloth)  will  do  much,  however, 
to  reassure  the  timorous  and  encourage  the 
boldly  upright.  The  following  resolution  moved 
by  Dr.  Samuel  Wilks  and  seconded  by  Dr. 
Lionel  Beale  was  carried  unanimously  :  "  That, 
while  the  College  thinks  it  desirable  not  to 
fetter  the  actions  of  the  fellows,  members,  or 
licentiates,  with  reference  to  any  opinions  they 
may  adopt,  it  nevertheless  expresses  its  opinion, 
that  the  assumption  or  acceptance,  by  members 
of  the  profession,  of  designations  implying  the 
adoption  of  special  modes  of  treatment,  is 
opposed  to  those  princifiles  of  the  freedom  and 
dignity  of  the  profession  which  should  govern 
the  relations  of  its  members  to  each  other  and 
to  the  public  ;  the  College,  therefore,  expects 
that  all  its   fellows,  members,  and  licentiates 


62 


CANADIAN  JOURNAL 


will  uphold  these  principles  by  discountenancin*:; 
those  who  trade  upon  such  designations." 

We  direct  attention  to  this  fact  especially 
because  we  have  heard  within  the  last  few 
days  of  a  well-known  medical  man  in  this  city 
who  has  recently  met  in  consultation  two 
prominent  and  pronounced  followers  of  Hahne- 
mann, who  have  not  even  a  degree  from  a  recog- 
nized University,  or  a  diploma,  from  a  regular 
Ck)llege,  to  commend  them  to  his  gracious  and 
favourable  consideration.  One  of  them,  in  fact, 
holds  such  peculiar  views  that  he  was  able  to 
certify,  the  other  day,  to  our  personal  know- 
ledge, that  a  certain  patient  was  suffering  from 
typhoid  fever  "  which  is  not  an  infectious  nor 
contagious  disease."  The  gentleman  to  whom 
we  reftr  as  not  being  fearful  of  besmirching 
his  immaculate  garments  by  contact  with  the 
unclean,  pi-ofesses  surgery,  and  may,  therefore, 
seek  to  justify  himsdf  before  his  conscience  by 
taking  refuge  behind  Mr.  Hutchinson's  very 
fallacious  and  short-sighted  argument  that  the 
knife  and  the  catheter  are  the  same  in  the 
hands  of  the  rational  and  the  homoeopath. 
Does  the  pruritus  secandi  constitute  the  sur- 
geon ;  or  are  the  great  principles  of  pathology 
and  diagnosis  equally  essential  to  medical  and 
chirurgical  practice  1  Whether  is  more  impor- 
tant the  incision  of  an  hepatic  abscess  or  the 
recognition  of  its  presence  1  But  this  liberal- 
minded  and  widely  sympathetic  surgeon  is  also 
a  licentiate  of  the  Royal  College  of  Physicians, 
and  we,  theiefore,  trust  that  the  expression  of 
the  opinion  of  his  college,  which  we  have 
quoted,  in  the  premises  may  not  be  lost  upon 
him,  and  that  this  latest  offence,  though  not 
his  first,  against  the  ethics  of  our  craft,  may 
happily  prove  to  be  his  last.  It  used  to  be  said 
that  as  the  homojopaths  had  not  taken  to 
surgery,  surgery  w>«s  the  salvation  of  medi- 
cine. This  broken  reed,  however,  has  at  length 
let  us  wholly  down,  since  it  can  be  no  longer 
doubted  that  even  though  they  suffer  the 
domain  of  surgery  to  lie  inviolate  from  the 
intrusion  of  their  preposterous  tenets,  yet  they 
succeed  in  prostituting  some  of  the  tillers  of 
that  noble  soil,  just  as  tiiey  might  hire  a  com- 
mon mechanician,  to  serve  their  ends.  We  freely 
grant  the  liberty  of  untrammelled  thought 
and  action  (not  transgressing  the  bounds  of  right 


and  equity)  to  every  man,  but  we  claim  for  his 

fellows,  likewise, the  right  to  judge  of  his  eccen- 
tricities and  follies,  and  to  act  accordingly.  The 
common  conscience  of  the  profession  has  long 
since  recognized  the  profession  of  the  exclusive 
doctrine  ofsimUia  similibus  and  of  dynamisation 
by  division  to  be  an  arrant  cheat — a  lie  ;  and  the 
verdict  of  the  common  judgment  is  that  those 
who  countenance  the  practice  by  association  in 
consultation  with  its  professors  are  equally  and 
inexcusably  participites  crimitds  in  foisting  a 
fraud  upon  the  public.  With  such  of  necessity 
honest  men  can  have  no  intercourse  or  com- 
merce, no  community  of  sentiment  or  aim. 


INAUGURAL   MEETING   OF  THE   TO- 
RONTO SCHOOL  OF  MEDICINE 
MEDICAL  SOCIETY. 

This  Society,  to  which  we  referred  in  our 
last  issue,  decided  that  its  first  meeting  should 
be  an  open  one,  and,  in  accordance  with  this 
decision,  a  public  meeting  was  held  on  Saturday 
evening,  January  H,  in  the  larger  of  the  two 
lecture  rooms  in  the  building  of  the  Toronto 
School  of  Medicine,  which  was  attended  by  a 
large  number  of  students,  members  of  the 
faculty,  and  other  physicians  residing  in 
Toronto.  Among  those  present  (apart  from 
the  faculty  members)  were  Drs.  Worjjman, 
Burns, O'Reilley,  Rosebrugh,  Cameron,  Playter, 
Palmer,  Wilson,  Martin,  Nevitt,  McPhedran, 
Davidson,  Smith,  Fisher,  Watt,  Mai-tin,  Going, 
King,  Robinson,  Dr.  Smith,  Principal  Ontario 
Veterinary  College,  and  others. 

Dr.  James  H.  Richardson  occupied  the  chair. 

The  President,  Dr.  A.  H.  Wright,  read  his 
Inaugural  Address,  in  which  he  referred  to  the 
objects  and  prospects  of  the  Society,  the  very 
prosperous  condition  of  the  School  at  the 
present  time,  and  concluded  with  some  general 
remarks  upon  the  profession  of  medicine. 

A  discussion  ensued  on  the  "  Causes  of  the 
Present  Epidemic  of  Typhoid  Fever,"  which  was 
opened  by  Mr.  W.  H.  Montague,  who  read  an 
exhaustive,  paper  on  the  subject.  (Tiu  }  aper 
appears  in  this  issue  of  the  Jouri.al).  Messrs. 
G.  S.  Cleland,  R.  M.  Coulter,  and  Patterson, 
gave  their  views  on  the  subject.  The  discussion 
was  interesting,  instructive,  and  very  ably  con- 


OF  MEDICAL  SCIENCE. 


63 


ducted,  and  we  must  congratulate  the  Scliool 
and  this  young  Medical  Society  upon  the 
marked  ability  shown  by  the  student  members 
at  their  inaugural  meeting.  It  was  a  subject 
of  general  remark,  on  the  part  of  those  present, 
that  such  a  discussion  would  have  done  honour 
to  any  Medical  Society  in  the  country. 

After  the  students  had  spoken,  some  of  the 
physicians  present  were  called  on  to  speak,  and 
in  response  Drs.  Graham,  O'Reilley,  Smith, 
Cameron,  Workman,  and  Richardson,  (the 
Chairman)  addressed  the  Meeting  on  the  sub- 
ject under  discussion,  and  at  the  same  time 
expressed,  in  the  most  cordial  and  kindly 
manner,  their  best  wishes  for  the  success  of  all 
the  undertakings  of  the  Society,  including  their 
meetings  for  discussions  on  Medical  subjects, 
and  also  their  Reading-room  and  Library. 

One  of  the  most  pleasing  features  of  the 
entertainment  was  the  oflFer  of  two  prizes  (a 
pocket  medicine  case,  and  a  clinical  thei*- 
mometer)  by  Mr.  E.  A.  Smith,  to  be  given  for 
the  best  papers  on  subjects  as  prescribed  by 
himself  in  his  letter,  which  was  read  by  the 
President. 

Before  adjourning,  the  thanks  of  the  Society 
were  given  to  Mr.  E.  A.  Smith  for  his  generous 
offer ;  to  the  Faculty  of  the  School,  for  giving 
and  furnishing  the  large  and  commodious  room 
for  tlie  use  of  the  Society  as  their  Reading- 
room  and  Library  ;  and  to  the  Chairman  for 
his  kindness  in  presiding  over  the  meeting. 


The  University  Examinations. — Below  is 
given  the  list  of  the  examiners  for  the  Univer- 
sity of  Toronto  for  the  year  1882  :  Medicine  — 
Physiology  and  Pathology,  Geo.  Wilkins,  M.D., 
University  of  Toronto,  Montreal ;  Medicine  and 
Thereapeutics,  F.  R.  Eccles,  M.B.,  University  of 
Toronto,  London;  Midwifery  and  Medical  Juris, 
prudence,  D.  B.  Eraser,  M.B.,  University  of 
Toronto,  Stratford  ;  Clinical  Surgery  and  Medi- 
cine, Chas  O'Reilly,  M.D.,C.M.,  McGill  College, 
Superintendent  General  Hospital,  Toronto- 
Medicine  and  Arts — Chemistry,  W.  H.  Ellis, 
M.A.,  M.B.,  Univei-sity  of  Toronto,  Professor 
of  Chemistry,  School  of  Science,  Toronto; 
Natural  Philosophy,  Prof.  R.  Ramsay  Wright, 
M.A.,  B.Sc,  University  of  Edinburgh. 


GUITEAU'S  PLEA  OF  INSANITY. 

We  transcribe  the  following  from  the  Lon- 
don Lancet  as  it  expresses  our  views  better 
than  language  of  our  own  could  do  : — 

The   trial  of  Guiteau  will,  even  if  it   should 
answer   no  more  immediate  purpose,  help    to 
place  the  "plea  of  insanity"  in  a  new  light ; 
and  as  it  is  impossible  that  this  plea  can    be 
placed  in  a  worse  light  then  that  in  which  it 
stands  at  this  moment,  not  only  as  regards  the 
assassin    in  question,  but   wrong-doers  of    all 
classes   and  in  every  country,  we  may    cherish 
the  hope  that  something  good  and  useful  will 
hereafter   be  found  to  come  out  of  what  now 
appears  to  be  both  evil  and  supremely  ridiculous- 
Making  all  due  allowancps  for  the  differences  of 
procedure  which  exist   in  the  working  out  o*^ 
judicial   processes  in  the  United  States  and  in 
England,  it  must,  we  think,  be  admitted  by  the 
most  patriotic  of  Americans  that  no  such  fiasco 
of  justice  and  common  sense  could  have  occurred 
in  the  old  country  as  that  which  has  happened 
in   the  United  States  in  connection  with    the 
farcical  trial  of  the  avowed  murderer  of  Presi- 
dent   Garfield.      Nothing,  however,  is   further 
from  our  purpose  than  to  comment  ungraciously 
on  a  spectacle  which  is  doing  much  to  make 
American  judicial   proceedings   the    laughing- 
stock of  the  world.      We  are  concerned  with 
the  cause- actual  or  pretended— of  the  business 

namely,  the  allegation  that  Guiteau  is  insane  . 

The  mere  fact  that  the  defence  was  a  plea  of 
insanity  ought  obviously  to  have  barred  his 
own  action  in  the  matter.  As  it  is,  Guiteau,  if 
really  in  ane,  is  damaged  by  being  allowed  to 
make  a  spectacle  of  himself;  while  if  not 
insane  he  is  encouraged  to  feign  madness. 
Nothing  so  much  humiliates  the  medical  pro- 
fession in  this  country  as  a  trial  in  which  the 
plea  of  insanity  is  raised  as  a  subterfuge,  and 
experts  are  called  to  give  evidence  on  opposite 
sides.  In  America  the  humiliation  is  even 
greater  than  it  is  here.  Surely  there  must  be 
some  men  of  position  in  the  specialty  of  mental 
disease  who  could  be  called  in,  and  who  would 
not  give  utterance  to  the  nonsensical  views  put 
forth  as  "scientific!"  The  confounding  of 
phrenology,  phyHiognoniy,  and  symptoms,  is 
discreditable  and  damaging.  It  will  be  more 
than  ever  difficult  io  obtain  a  hearing  for 
genuine  medical  evidence  in  any  court  after  the 
spectacio  of  folly  now  offered  to  the  public  gaze 
in  America. 


64 


CANADIAN  JOURNAL 


A  MEDICAL  LIBRARY  AND  A  REGIS- 
TER OF  NURSES. 

The  scientific  medical  man  of  the  day  in 
order  to  keep  abreast  of  the  progress  of  medi- 
cal science,  requires  to  have  access  to  the  litera- 
ture of  his  art.  This  literature,  already  large, 
is  rapidly  accumulating.  Private  libraries 
cannot  contain  it  all.  A  public  library  is 
then  a  necessity. 

The  profession  in  Toronto,  with  its  Hospitals 
and  Medical  Schools,  and  Medical  Societies, 
has  no  library.  And  in  this  it  is  behind  the 
other  learned  professions,  for  the  lawyers  have 
the  fine  library  at  Osgoode  Hall  ;  the  legis- 
lator.s  have  their  librai-ies ;  the  theologians 
theirs;  the  University  theirs.  The  medical 
profession  alone  has  no  storehouse  of  its  litera- 
ture. This  is  a  grave  fault,  aud  it  behooves  us 
to  see  that  it  is  corrected.  To  found  a  public 
medical  library,  demands  the  united  action  of 
the  entire  profession  in  the  city.  An  annual 
sum  from  each  member  of  the  profession  (the 
amount  not  to  be  burdensome),  would  be 
sufficient  for  a  beginning.  A  suitable  room 
must  be  obtained — this  under  proper  repre 
sentation  might  be  in  the  hall  of  the  Ontario 
College  of  Physicians  and  Surgeons ;  and  a 
librarian  appointed  who  would  have  to  be  paid 
a  certain  salary.  These  are  a  few  of  the 
expenses  connected  with  the  establishment  of 
any  institution  of  this  kind. 

Had  we  some  such  central  and  common 
meeting-place,  it  would  soon  become  used  as  a 
centre  for  diffusing  useful  information  upon 
common  topics  in  connection  with  the  pro- 
fession. A  notable  use  to  which  it  might  be 
made  subsidiary  is  the  knowledge  of  the  resid- 
ence of  trained  nurses.  Trained  nurses  could 
be  encouraged  to  send  their  addresses  to  the 
librarian,  who  should  be  kept  posted  as  to  their 
movements  and  upon  application  could  im- 
mediately supply  a  nurse  to  any  part  of  the  city 
saving  the  practitioner  a  good  deal  of  trouble 
and  loss  of  time.  Such  a  plan  has  operated 
most  successfully  in  Boston. 

Let  the  profession  then  make  a  united  and 
determined  effort  to  gain  this  desirable  end, 
and  they  may  be  assured  of  success.  Let  them 
look  upon  it  as  an  investment,  and  they  will 
find  it  pay  a  good  and  lasting  interest. 


Veterinary  Schools. — The  Medical  Neioa 
in  its  issue  of  January  21st,  says  : — "  So  far  as 
we  know,  there  is  but  one  organized  school  of 
Veterinary  Medicine  in  America,  and  of  late 
years  but  little  has  been  beard  from  that."  "We 
presume  that  the  remark  must  have  been  in- 
tended to  apply  to  the  United  States  of 
Amei'ica  only  ;  otherwise  we  would  desire  to 
inform  our  contemj)orary  that  in  Canada  two 
excellent  Schools  of  Veterinary  Medicine  are  to 
be  found,  one  in  Montreal,  and  one  in  Toronto. 
In  the  latter  we  believe  there  are  over  120 
students  annually  in  attendance. 


Unprofessional  Advertising. — We  regret 
very  much  to  observe  in  the  Brooklin  Times 
for  January  3rd,  a  very  fulsome  and  disgusting 
notice  of  the  advent  of  a  new  practitioner. 
From  the  personal  knowledge  we  had  of  the 
gf-ntleman  mentioned,  some  eight  or  nine  years 
ago,  we  cannot  believe  that  the  publication  of 
the  notice  had  either  his  knowledge,  consent,  or 
approval ;  but  are  obliged  to  suppose  that  he  is 
the  victim  of  the  indiscretion  of  an  over-zealous 
friend.  May  the  Fates  save  him  from  such 
friends  in  future  ! 


The  Ontario  Veterinary  College  held  its 
annual  dinner  at  the  Walker  House  on  Friday 
evening,  the  27th  ult.  It  was  a  grand  success, 
highly  creditable  to  its  promoters  and  enjoy- 
able by  its  participants.  We  congratulate  the 
College  upon  the  high  position  it  has  attained 
and  are  pleased  to  learn  that  it  this  year 
numbers  some  120  pupils. 


PERSONAL. 


Dr.  Bascora,  of  Uxbridge,  is  recovering  from 
an  attack  of  typhoid  fever. 

Dr.  Machell,  of  Toronto,  is  also  recovering 
from  an  attack  of  the  same  disease. 

Dr.  Ferguson  also  has  resumed  active  work, 
and  Dr.  Jehu  Ogden  is  again  about. 

The  celebrated  Parisian  Alienist,  Brierre  de 
Boismont,  is  dead,  aged  83. 

Dr.  Draj)er,  President  of  the  Scientific  and 
Medical  Department  of  the  University  of  the 
City  of  New  York,  is  dead. 


OF  MEDICAL  SCIENCE. 


65 


The  Order  of  the  Cross  and  Collar  of  Kjiight 
Commander  of  the  Crown  of  Italy  has  been 
conferred  upon  Sir  William  MaoCormac  by 
King  Humbert, 

The  Birmingham  Medical  Review,  under  the 
able  editorship  of  Dr.  Robert  Saundby,  and 
which  formerly  appeared  as  a  quarterly,  is  now 
issued  monthly. 

Mr.  Malcolm  A.  Nicolson,  M.B.,  of  the 
Toronto  School  of  Medicine,  passed  the  primary 
examination  of  the  Royal  College  of  Surgeons 
on  the  9th  January. 

A  new  Chair  of  Nervous  Diseases  has  been 
created,  at  the  Faculty  of  Medicine  of  Paris,  to 
which  M.  Charcot  has  been  transferred  from 
that  of  Pathological  Anatomy. 

Prof.  Freund,  of  Strasbourg,  is  reported  to 
have  accepted  the  Chair  of  Obstetrics  at 
Breslau,  vacant  by  the  death  of  Otto 
Spiegelberg. 

Messrs.  J.  Stevens  k  Son,  Surgical  Instru- 
ment Makers,  have  removed  their  agency 
from  274,  Yonge  Street,  to  large  and  more 
convenient  pi-emises,  situated  at  40  Wellington 
Street  East,  Toronto. 

The  well-known  Philadelphia  Publishing 
Firm  of  Lindsay  <k  Blakiston  has  been  dis- 
solved, and  the  business  is  now  conducted  by 
Presley  Blakiston,  Son  <fe  Co.,  i012  Walnut  St. 

It  is  proposed  to  erect,  on  the  ground  con- 
tiguous to  the  University  of  Pennsylvania,  a 
School  of  Veterinary  Science,  a  Hospital  for 
Domestic  Animals,  Dormitories,  Museums,  a 
Training  School  for  Nurses,  and  Free  Library. 

Dr.  Reuben  J.  Harvey,  who  succeeded  Dr. 
Yeo  as  Lecturer  in  Physiology  in  the  Car 
michael  School  of  Medicine,  Dublin,  in  1872, 
died  on  28th  December,  from  typhoid  fever, 
aged  36.  The  disease  was  contracted  on  duty 
at  the  Cork  Street  Fever  Hospital. 

M.  Laborde  stated  at  the  Biological  Society 
that  in  the  preparation  of  aconitine  two  alka 
loids  are  obtained,  one  of  which,  napelline, 
gives  rise  to  hypnotic  effects  more  remarkable 
than  those  from  morphine.  He  is  at  present 
engaged  in  a  series  of  experiments  to  investigate 
the  physiological  properties  of  this  alkaloid. — 
Gaz.  dee  Hdp. 

The  death  is  announced  of  John  Flint  South, 
F.R.C.S.,  at  the  advanced  age  of  85,      He  will 


be  best  known  to  our  readers  as  the  Editor  and 
translator  with  notes  of  Otto's  "  Compendium 
of  Human  and  Comparative  Pathological  Ana- 
tomy," and  of  Chelius'  "  System  of  Surgery." 
He  was  a  ripe  scholar  and  careful  teacher; 
member  of  many  home  and  foreign  learned 
societies,  and  twice  President  of  the  Royal 
College  of  Surgeons  of  England. 

The  Medical  News,  long  published  in  connec- 
tion with  the  American  Journal  of  Medical 
Science,  and  the  Monthly  Abstract  re-appears, 
in  connection  with  the  former  and  instead  of 
the  latter,  as  a  weekly  of  the  same  stamp  as  the 
Lancet,  British,  and  Medical  Tim>es  and  Gazette, 
and  makes  a  fair  show  alongside  of  these  older 
confreres  which  we  have  all  learned  to  look  for  so 
eagerly  and  love  so  well.  Floreat  in  perpetuam. 
The  editor's  name  is  not  disclosed,  but  the 
publication  is  conducted  by  H.  C.  Lea's,  Son 
<fe  Co.,  of  Philadelphia, 

The  Transactions  of  the  International  Medi- 
cal Congress  of  1881,  are  now  issued  in  four 
thick  royal  octavo  volumes,  comprising  2,548 
pages  of  closely  printed  matter,  together  with 
180  illustrations.  Owing  to  the  size  of  the 
work  greatly  exceeding  the  original  expecta- 
tion it  has  been  found  that  the  guinea  sub- 
scription will  only  cover  about  two-thirds  the 
cost,  and  it  is,  therefore,  hoped  that  every 
subscriber  will,  upon  receipt  of  his  volumes,  not 
fail  to  remit  the  additional  half-guinea  neces- 
sary to  exempt  the  guarantee  fund  from  being 
called  upon.  The  next  Congress  meets  in 
Copenhagen  in  1884. 


The  Cycle  of  Western  Farming. — A 
writer  in  an  Illinois  paper  says  :  "  The  average 
Western  farmer  toils  hard  early  and  late,  often 
depriving  himself  of  needed  rest  and  sleep — for 
what  ?  To  raise  corn.  For  what  ?  To  feed 
hogs.  For  what  1  To  get  money  with  which 
to  buy  more  land.  For  what  ?  To  raise  more 
com.  For  what  1  To  feed  more  hogs.  For 
what  1  To  buy  more  land.  And  what  does 
he  want  with  more  land  1  Why,  he  wishes  to 
raise  more  corn — to  feed  more  hogs — to  buy 
more  land — to  raise  more  corn — to  feed  more 
hogs — and  in  this  circle  he  moves  until  the 
Almighty  stops  his  hoggish  proceedings." — 
Thntggist's  Circular. 


66 


CANADIAN  JOURNAL 


^aak  ilotirfjs. 


The  Hygiene  of  the  Eye.  An  A ddresa  to  Phy- 
ticiaru.  By  Charles  A.  Oliver,  A.M.,  M.D. 
(Reprint  from  Medical  and  Surgical  Reporter). 


Obstetric  and  Gyneecological  Literature,  1876- 
1880.  By  James  R.  Chadwick,  M.D.,  Boston, 
Mass.  (Reprint  from  Boston  Medical  and 
Surgical  Journal. ) 


Quarterly  Report  oj  tlie  Kansas  State  Board 
of  Agriculture' for  Quarter  ending  December 
31«/,  1881.  F.  D.  Coburn,  Sec.  Topeka, 
Kansas. 


Case  0/  Obliteration  of  the  Portal  Vein  {Pyle- 
phlebitis Adhesiva).  By  Wm.  Osler,  M.D., 
M.R.C.P.Lond.,  Prof.  Instit.  of  Med.  McGill 
University.  (Reprint  from  Journal  Anatomy 
and  rhysiology.)     Vol.  XV F. 


A  Manual  of  Ophthalmic  Practice.  By  H. 
S.  ScHELL,  M.D.,  Philadelphia.  D.  G.  Brinton, 
Philadelphia,  1881.  This  is  an  unpretentious, 
but  good  book,  giving  a  good  deal  of  useful  in- 
formation in  small  compa.ss.  There  is  but  little 
fault  to  find,  and  much  could  be  said  by  way  of 
commendation. 

Address  delivered  at  the  Dedication  of  the 
Hall  of  the  Boston  Medical  Library  Associa- 
tion, Decembers,  1878.  By  Oliver  Wendell 
Holmes,  M.D.,  with  speeches  by  various  others. 
List  of  a  Loan  Exhibition  of  Medical  Por- 
traits. Report  of  the  Librarian,  James  R 
Chadwick,  M.D.,  read  at  the  Sixth  Annual 
Meeting  on  October  4th,  1881,  And  the 
Report  of  F.  C.  Shattuck,  M.D.,  on  the 
Directory  for  Nurses. 


The  Nurse  and  Mother.     By   Walter  Coles, 

M.D.,   Consulting  Physician,   to    St  Ann's 

Lying-in    Asylum,    S^    Louis,    etc.  J.    H. 
Chambers  <k  Co.,  Sf.  Louis. 

This  little  book  contains  minute  instructions 
for  the  guidance  of  t'  e  Monthly  Nurse  in  her 
management  of  the  mother  and  infant,  and  also 
gives  useful  hints  to  the  mother  with  reference 
to  dressing  and  feeding  her  child.       We  wish 


every  mother  could  read  these  invaluable  direc- 
tions (all  of  which  we  entirely  approve  of),  and 
act  upon  them.  It  would  follow  as  an  inevit- 
able result  that  we  should  see  fever  puny,  sickly 
babes  than  now.  The  work  will  be  found  in- 
teresting and  useful  to  nurse  and  mother,  and 
we  may  also  add,  to  the  young  doctor,  who  has 
not  had  during  his  course  many  opportunities 
of  studying  the  details  of  the  Lying-in  room. 


A  Treatise  on  tJie  Disea.'^es  of  Infancy  and 
Childhood.  By  J.  Lewis  Smith,  M.D. 
Fifth  Edition.  Tnoroiighly  Revi.sed.  Phila- 
delphia :    Henry  C.  Lea's,  Son  &  Co.      1881. 

The  appearance  of  a  fifth  edition  of  this 
work  is  suflBcient  attestation  of  its  great  value 
to  the  practitioners  of  the  country,  and  of  the 
use  they  are  disposed  to  make  of  it.  The  more 
widespread  its  use  and  the  more  general  the 
diffusion  of  the  practical  wisdom  it  contains, 
the  more  rejoiced  must  be  all  lovers  of  the 
little  folk  of  whose  ills  it  treats ;  for  unques- 
tionably it  is  the  best  work  on  the  Maladies  of 
Childhood  in  the  English  language,  and  in  any 
foreign  language  we  know  of  no  work  which 
will  compare  with  it.  That  the  Fifth  Edition 
has  been  thoroughly  revised  and  brought  up  to 
date  an  attentive  (or  even  careless)  perusal 
will  abundantly  disclose.  We  wish  it  God- 
speed in  its  beneficent  mission. 


Eczema  and  its  Management.  A  Practical 
Treatise  based  on  the  study  of  2,500  cases  of 
the  disease.  By  L.  Duncan  Bulkley,  A.M., 
M.D.,  New  York.  New  York:  G.  P.  Put- 
nan's  Sons,  27  and  29  West  23rd  Street. 
Toronto  :  N.  Ure  &  Co.     1881. 

The  present  volume,  composed  in  part  of 
previous  essays  of  the  author,  certainly  consti- 
tutes the  best  and  fullest  monograph  upon  the 
subject  in  any  language.  It  is  made  upof  sixteen 
chapters ;  of  which  the  first  treats  of  general 
considerations,  definition,  and  nosology.  The 
affection  is  defined  as  a  "  non-contagious,  in- 
flammatory disease  of  the  skin,  of  constitutional 
oi-igin,  acute  or  chronic  in  character,  manifest- 
ing any  or  all  of  the  results  of  inflammation  at 
once  or  in  succession,  and  accompanied  by 
burning  and  itching."  With  regard  to  noso- 
logy it  is  accordingly  classed  amongst  the  exuda- 
tive or  inflammatory  affections  in  Class    TV. 


OF  MEDICAL  SCIENCE. 


6T 


of  the  author's  excellent  Nosological  Catalogue, 
familiar  to  all  readti-s  of  the  Archives  of  Der- 
matology. With  regard  to  frequency,  the 
author's  individual  experience  would  estimate 
the  occurrence  of  eczema  in  34^  per  cent,  of  all 
Diseases  of  the  Skin.  The  general  practitioner's 
average  would  indubitably  place  it  much 
higher.  The  symptoms,  Pathological  Anatomy 
and  the  Acute,  Sub-acute,  and  Chronic  Forms 
are  dealt  with  in  Chapters  III.  and  IV.  The 
Diagnosis  and  Prognosis  occupy  Chapter  V, 
Twenty-eight  affections  of  the  skin  are  eaumer- 
ated  as  at  times  reqairiug  differentiation  from 
this  disease.  The  Prognosis  under  given  con- 
ditions is  invariably  good.  Chapters  VI.  and 
VII,  ably  discuss  the  Local  and  Constitutional 
Nature  of  Eczema  and  its  Predisposing  and 
Exciting  Causes.  From  the  deiinition  it  will 
be  observed  that  the  Constitutional  view  has 
been  adopted  in  opposition  to  the  Grerman 
School,  and  we  are  bound  to  say  it  is  most 
satisfactorily  and  cogently  defended.  The  fre- 
quency and  importance  of  local  exciting  causes 
is  none  the  less  duly  and  frankly  admitted. 
The  Constitutional  and  Local  Treatment  are 
fully  considered  in  Chapter  VIII.  Then  follow 
six  special  chapters  on  the  Management  of 
Infantile  Eczema,  of  Eczema  of  Face  and 
Scalp,  of  Hands  and  Arms,  of  Feet  and  Legs, 
of  Anus  and  Genital  Region,  of  the  Trunk, 
and  of  General  Eczema.  The  two  concluding 
chapters  are  devoted  to  the  Diet  and  Hygiene 
and  the  Therapeutics  of  Eczema ;  the  last  con- 
taining a  valuable  collection  of  well -proved 
formulae.  He  who  reads  the  book  attentively, 
cannot  fail  to  be  well-informed  on  the  subject 
of  which  it  treats;  and  being  so  will  find 
himself  in  a  position  to  scientifically  grapple 
with  and  subdue  at  least  one-half  of  all  the 
dermatological  cases  falling  into  his  hands. 
Being  ardent  disciples  of  the  authoi*,  we  can- 
not find  much  fault  with  his  doctrines  ;  and  it 
seems  to  us  that  the  most  serious  criticism 
of  the  work  must  fall  upon  its  arrangement 
which  gives  rise  to  some  diffuseness  and  need- 
less iteration.  Doubtless  gutta  cavat  lapidem 
and  the  incessant  insistance  upon  a  fact  ensures 
its  ultimate  appreciation  ;■  but  here  the  prin- 
ciples are  so  well  enunciated  in  the  first  place, 
and  appeal  so  strongly  to  the  judgment  of  the 


reader,  that  their  needless  repetition  would 
appear  to  be,  typographically  considered,  "waste- 
ful and  ridiculous  excess."  We  recommend 
the  volume  to  our  readers  on  its  merits,  feeling 
assured  that  other  commendation  will  be  found 
superfluous. 


The  Science  and  Art  of  Midwifery.  By  Wm. 
Thompson  Lusk,  A.M.,  M.D.,  New  York. 
New  York :  D.  Appleton  *k  Co.,  1,  3,  and  6, 
Bond  Street.     1882. 

It  was  about  time  that  a  new  work  on 
midwifery,  by  an  American  author  might  be  ex- 
pected, and  accordingly  almost  simultaneously 
the  works  of  Lusk  and  Glisan  make  their 
appearance.  From  his  position  in  connection 
with  Bellevue  and  his  well-known  studious 
habits  much  might  justly  be  expected  from  Dr, 
Lusk,  and  we  are  happy  to  be  able  to  say  that 
all  reasonable  expectations  are  herein  more 
than  fully  realized.  The  great  advances  made 
of  late  years  in  this  department  by  French, 
German,  and  British  writers  have  been  fully 
noted,  and  their  contributions  carefully  sifted 
and  discerningly  appraised  with  a  view  to  incor- 
poration in  this  treatise  of  all  that  was  good 
and  true. 

The  Physiological  Anatomy  of  the  Female 
Organs  of  Generation  is  first  considered  and 
an  admirable  description  presented  by  no  means 
the  stereotyped  account  of  the  older  text-books, 
but,  as  we  think,  truer  to  life.  The  position  of 
the  ovary  is  represented  as  lying  too  transverse, 
however.  The  Physiology  of  the  Ovum  is  then 
dealt  with  in  two  highly  excellent  chapters. 
The  Physiology  of  Pregnancy  follows  and  then 
Pregnancy  and  Labour.  The  descriptions 
throughout  are  orignal,  clear,  fresh,  and  con- 
cise. The  puerperal  state  is  aftewards  treated  of 
in  an  admirable  chapter  in  which  nothing" 
needful  appears  to  have  escaped  attention,  and 
which  fully  represents  the  daily  routine  of  the 
careful  and  attentive  obstetrician.  The  Path- 
ology of  Pregnancy  occupies  four  chapters 
which  fairly  embody  the  gist  of  nearly  all  valu- 
able contributions  to  the  subject.  Obstetric 
Surgery  has  six  chapters  devoted  to  it,  and  we 
certainly  think  that  here  are  to  be  found  the 
best  descriptions  and  directions  for  the  vai'ious 
obstetric  operations  to  be  found  in  any  text- 
book of  midwifery  extant.       Tne    author   is  a 


68 


CANADIAN  JOURNAL 


stroug  advocate  of  chloroform  as  an  anodyne  in 
labour,  but  for  any  operations  after  delivery,  he 
greatly  prefers  ether  and  believes  chloroform 
to  be  dangerous.  The  use  of  the  forceps  is  well 
set  forth  ;  and  for  operations  at  the  brim  our 
author  highly  lauds  Tarnier's  pattern  or  his 
own  modification.  For  ourselves  we  think  the 
more  convenient  form  of  Studley  with  the 
double  perineal  curve,  lately  described,  is  more 
likely  to  come  into  general  use.  The  Path- 
ology of  Labour  is  treated  of  in  some  eleven 
chapters ;  those  upon  Contracted  and  Dis- 
torted Pelvis  being  especially  noteworthy  and 
important.  Ruptures  of  the  Genital  Canal  are 
likewise  admirably  described.  The  work  is 
dedicated  to  Foi-dyce  Barker,  and  it  is  there- 
fore especially  meet  that  it  should  be  crowned 
and  concluded  by  three  excellent  chapters 
on  the  Diseases  of  Childbed,  which  admirably 
reflect  the  sound  and  scientific  doctrines  of 
that  great  master.  The  book  is  abundantly 
illustrated  with  drawings  from  various  sources 
ehiefiy  German,  We  regret  that  time  and 
space  will  not  allow  of  our  noticing  the 
work  as  we  had  intended  ;  but  we  are 
sure  we  cannot  do  our  readers  greater  service 
than  in  urging  them  with  the  utmost  earnest- 
ness we  can  command  to  buy  the  book  and 
"  read,  mark,  learn,  and  inwardly  digest  it " 
for  themselves. 


Clinical  Lectures  on  the  Diseases  of  Old  Age. 
By  J.  M.  Charcot,  M.D.  Translated  by 
Leigh  Hunt,  B.  Sc,  M.D.,  with  additional 
Lectures,  by  Alfred  M.  Loomis,  M.D.,  N.Y. 
New  York  :  William  Wood  &  Co.,  27  Great 
Jones  St.     Toronto  :  Willing  &  Williamson. 

It  has  almost  become  an  accepted  fact  that 
a  place  in-  Wood's  Library  of  Medical  Authors 
should  be  regarded  a  sufficient  guarantee  of 
the  excellence  of  a  work.  M.  Charcot's  lec- 
tures form  no  exception  to  this  rule.  Many  of 
our  readers  are  probably  as  familiar  with  the 
writings  of  Loomis  as  of  Charcot,  and  though 
some  might  be  led  to  think  that  diseases  of  old 
age,  as  occurring  in  America,  do  not  con-espond 
in  clinical  history,  as  accurately  with  the  same 
diseases  so  vividly  portrayed  by  M.  Charcot,  as 
their  observation  would  lead  them  to  suppose 
they  ought,  still  they  will  recognize  a  close 
relationship. 


M.  Charcot's  introduction,  as  a  comparison 
between  the  medical  theories  of  ancients  and 
moderns,  will  be  interesting  to  all  readers.  It 
is  with  regret  we  have  to  notice  that  a  man  of 
such  renown  in  medical  science  as  M.  Charcot, 
should  so  far  belittle  himself  as  to  allow  even 
patriotic,  and  political  feelings  to  lead  him 
to  say,  "  But  not  without  regret  have  we 
but  lately  seen  an  eminent  man  confoUnd 
the  rights  which  his  high  position  as  a  scholar 
confers  upon  him,  with  the  political  power 
which  was  given  him  by  his  electors  in  Berlin, 
and  abuse  the  word  science  to  make  the  Germans 
hot-headed  at  the  expense  of  a  strict  patriotism." 

These  are  alltisions  to  a  discourse  delivered  in 
Hanover,  at  the  Congress  of  German  Naturalists, 
September  20th,  1865. 

But  as  an  offset  we  are  glad  to  add  to  this  M. 
Charcot's  quotation  from  Dr.  Graves,  (Lecons. 
do  la  Clinique  Medicale.  translated  by  Dr. 
Jaccoud,  Vol.  I.  p.  63,  1863. 

Reason,  says  Graves,  "  Reason  has  extended 
its  empire  from  the  old  to  the  new  continent — 
from  Europe  to  the  antipodes  ;  to-day  she  has 
the  whole  world  for  her  domain,  and  the  sun 
never  sets  upon  her  possessions.  Individuals 
take  rest,  but  the  general  intelligence  of  man- 
kind is  forever  sleepless." 

Charcot  deals  chiefly  with  gout  and  chronic 
rheumatism,  and  that  anomaly  rheumatic  gout, 
nodular  rheumatism,  rheumatic  arthritis,  as 
well  as  with  chronic  articular  rheumatism,  con- 
comitant diseases  of  gout,  its  etiology,  symptoma- 
tology, pathology,  &c.,  <kc. 

Dr.  Loomis  treats  of  diseases  of  far  greater 
interest  to  Americans  : — Senile  pneumonia, 
catarrh  of  bronchi,  asthma,  atheroma,  fatty 
heart,  apoplexy,  cerebral  softening,  chronic  gas- 
tric catarrh,  senile  constipation,  and  last,  but 
by  no  means  least  important,  senile  hyper- 
trophy of  the  prostate  gland. 

In  the  appendix  Charcot  gives  in  lectures 
xix.,  XX.,  and  xxi.,  much  interesting  informa- 
tion on  the  clinical  importance  ot  thermometry 
in  old  age,  dwelling  s|>ecially  upon  the  import- 
ance of  recognizing  the  difference  between  the 
axillary  and  central  temperature,  and  show- 
ing that  while  in  the  adult  the  difference 
between  the  axillary  and  rectal  temperature  is 
(carefully  taken)  usually  very  slight,  this  is 
not  so  in  old  age.  In  the  senile  period  of  life, 
in  the  pathological,  and  above  all  in  the  febrile 
state,  a  difference  of  as  much  as  six  degrees, 
Fahr.  has  been  observed  when  the  symptoms 
even  portended  collapse.  We  commend  the 
book  to  our  readers. 


OF  MEDICAL  SCIENCE. 


69 


TORONTO  MEDICAL  SOCIETY. 

17th  November,  1881. — The  Society  met  at 
8.30  p.m.  The  President  in  the  Chair.  The 
minutes  of  the  last  meeting  were  read  and 
approved. 

Dr.  Macdonald  showed  a  vermiform  appendix 
taken  from  a  patient,  who,  for  some  days  prior 
to  his  death,  had  been  suffering  from  localized 
peritonitis  in  "the  region  of  the  caecum.  The 
appendix  showed  two  points  of  ulceration  -with 
perforation,  and  in  its  interior  it  contained  a 
hardened  nodule  of  fcecal  matter,  which  was 
situated  between  the  points  of  ulceration. 

Dr.  Nevitt  mentioned  a  case  of  fcecal  im- 
paction, where  there  was  perforation ;  death 
resulting  in  thirty-six  hours. 

Dr.  Cameron  next  showed  a  case  of  pseudo- 
hypertrophic muscular  paralysis  in  a  lad  aged 
eleven.  He  gave  a  detailed  account  of  the 
family  history,  which  showed  that  the  disease 
could  not  be  traced  in  any  of  the  patient's  an- 
cestors or  members  of  his  own  family.  The 
patient  was  quite  well  until  about  three  years 
of  age  ;  after  that  there  began  to  be  loss  of 
power,  and  feats  of  strength  and  agility  which 
he  could  not  perform  were  easily  accomplished 
by  children  of  more  tender  years,  while  the 
excessive  enlargement  of  the  muscles  of  the 
calf  were  the  subject  of  much  admiration. 
The  patient,  when  placed  on  his  back,  has  no 
power  to  regain  the  erect  posture  without 
assistance,  and  his  mode  of  progression  is 
peculiar,  especially  when  he  ascends  the  stairs. 
There  is  excessive  prominence  of  gastro- 
cnemii  and  solei,  while  the  muscles  of  the 
brachial  region  are  somewhat  wasted,  and  there 
is  well-marked  lordosis.  The  treatment  adopted 
is  by  the  administration  of  cod-liver  oil,  the 
syrup  of  the  iodide  of  iron,  and  arsenic. 
The  P.M.  lesion  is  always  the  same  in  the 
muscles,  but  there  is  a  want  of  uniformity  in 
the  lesion  of  the  cord. 

The  President  then  mentioned  several  cases 
which  had  recently  come  under  his  notice, 
among  which  were,  1st.  A  case  of  ovarian 
tumour,  which  was  a  multiple  cyst,  and  con- 
tained about  50  lbs.  of  fluid  in  its  interior  ; 
2nd.  A  gun-shot  wound  of  the  arm,  in  which 


there  was  no  discharge  from  the  track  of  the 
ball,  the  wound  having  been  dressed  under  the 
spirit  lotion.  He  also  mentioned  the  beneficial 
effect  hyoscyamine  had  in  quieting  patients 
suffering  from  acute  mania,  given  in  doses  of 
\  to  ^  oi  3k  grain,  and  also  related  the  effect 
the  dose  of  ^  of  a  grain  had  upon  himself. 

Dr.  Rosebrugh  then  read  his  paper  on 
**  Electricity  in  the  Treatment  of  Special  Dis- 
eases," a  full  report  of  which  has  appeared  in 
the  Canada  Lancet. 

December  1st,  1881. — The  Society  met  at 
8.15  p.m.  The  President  in  the  Chair.  The 
minutes  of  the  last  meeting  were  then  read 
and  approved. 

Dr.  Going  was  then  proposed  a  member  of 
the  Society. 

Dr.  Oldright  then  showed  a  man,  who, 
eighteen  months  ago,  had  received  a  com- 
minuted fracture  of  his  right  tibia  and  fibula 
in  their  lower  third.  Six  weeks  after  the 
accident  the  fractured  limb  became  swollen  and 
oedematous,  and  sometime  afterwards  the  sound 
limb  also  became  swollen.  The  case,  as  pre- 
sented to  the  Society,  showed  great  swelling 
and  cedema  of  the  affected  limb,  and  an  in- 
dolent ulcer  on  its  anterior  and  inner  surface. 
The  patient  is  of  temperate  habits.  He  has 
no  cardiac  affection ;  and  the  urine,  when  ex- 
amined shortly  after  the  accident,  was  found 
normal.  Dr.  Oldright  asked  for  a  solution  of 
the  case,  but  an  answer  was  wanting. 

Dr.  Graham  next  exhibited  a  girl,  aged  five, 
whose  mode  of  progression  was  awkward  and 
difficult,  and  the  appearance  simulated  some- 
what that  of  double  hip  disease.  The  affection 
has  always  existed.  Dr.  Graham  had  seen  three 
cases  similar  to  this  disease.  Tendon  reflex, 
although  absent  in  this  case,  is  well-marked  in 
some. 

Drs.  Canniff,  Oldright,  Cameron,  and  others 
discussed  the  case. 

Dr.  Cameron  exhibited  a  piece  of  gravel 
(about  the  size  of  a  small  castor-oil  bean)  which 
he  had  removed  after  it  had  existed  in  the  ex- 
ternal auditory  canal  for  two  and  a-half  years 
without  symptoms. 

Dr.  Graham  showed  a  piece  of  cotton  wool 
which  he  had  removed  from  the  naris  of  a 
child,  where  it  had  been  lodged  three  or  five 


70 


CANADIAN  JOURNAL 


years,  and  iu  consequence  of  which  the  child 
suffered  from  ozena. 

Dr.  Rosebrugh  then  read  a  continuation  of 
his  paper  on  "  The  Uses  of  Electricity  in  the 
Treatment  of  Special  Diseases." 

Dr.  Rosebrugh,  of  Hamilton,  being  present, 
made  a  few  lemarks  upon  the  paper,  and  the 
Society  then  adjourned. 


BRANT  MEDICAL  ASSOCIATION. 

The  regular  quarterly  meeting  of  the  Society 
was  held  at  the  Kerby  House,  Brantford,  Dec. 
6tb.  The  members  present  were — Drs.  Griffin, 
Philip,  Harris,  Kitchen,  Clarke,  and  Winskel. 
The  following  gentlemen  were  elected  officeis 
for  the  ensuing  year  : — Dr.  Kitchen,  St. 
George,  President ;  Dr.  Sinclair,  Paris,  Vice- 
President  ;  Dr.  Harris,  Brantford,  Secretary- 
Treasurer. 

A  .paper  was  read  by  Dr.  Philip  on  the 
"  Antiseptic  Treatment  of  Phthisis,"  and  notes 
of  a  case  of  "  Latent  Typhoid  Fever,"  by 
Dr.  Harris.  A  long  and  interesting  discussion 
took  place,  by  all  the  members  present,  on 
these  two  papers. 

After  some  routine  business  the  Society 
adjourned,  to  meet  again  at  Brantford  on 
the  first  Tuesday  in  March,  1882. 

«  MM  ♦  »    . 

Beef-Tea  anb  Urine. — It  is  rather  a  novel 
idea  that  in  taking  a  cupful  of  beef-tea  we 
are  really  drinking  what  is  equivalent  to  a 
cup  of  urine.  According  to  Mr.  Masterman, 
however,  who  not  long  since  published  a 
chemica'  analysis  of  beef-tea,  the  two  are  as 
alike  as  may  be,  only  that  urine  appropriately 
contains  more  urea  and  uric  acid.  And  »ow 
comes  Dr  Neale,  of  London,  who  has  been, 
apparently,  in  the  East  Indies,  and  not  only 
assures  us  that  urine  is  used  as  a  vehicle 
for  (less  agreeable  1)  medicines,  but  that,  "  as  a 
stimulant  and  general  pick-up,  I  have  fre- 
quently seen  a  glass  of  a  child's  or  a  young 
girl's  urine  tossed  off  with  great  gusto  and 
apparetit  benefit." 

Reduced  tu  straits,  we  presume  we  might  so 
use  it,  but  we  confess  that,  usually,  "as  a 
stimulant  and  general  pick-up,"  we  mightily 
prefer  the  other  form  of  the  cup  that  cheers  but 
does  not  inebriate. — Medical  New$. 


^im\\mtm%. 


Toothache. — There  are  some  cases  instantly 
cured  by  the  application  of  a  plug  of  lint  dipped 
in  sulphurous  acid  and  inserted  in  the  hollow 
tooth. 


Cheap  Water-beds  to  Prevent  Bed-sores. — 
Dr.  Morton  (at  the  Philadelphia  Academy  of 
Surgery)  mentioned  the  use,  at  the  Pennsyl- 
vania Hospital  for  the  Insane,  of  water-beds 
made  by  stretching  a  piece  of  gum-cloth  over  a 
shallow  trough. — Medical  News. 


Slow  Pulse. — At  a  recent  meeting  of  the 
Birmingham  and  Midland  Counties  Branch  of 
the  British  Medical  Association,  Dr.  Simon 
showed  a  patient  with  a  slow  pulse  who  had 
been  under  observation  for  thirteen  or  fourteen 
years,  and  whose  case  had  been  recorded  in  the 
Medical  Times  and  Gazette  by  Dr.  Russell.  The 
pulse  rate  has  varied  from  12  to  38  or  40. 

Huxley  predicts  that  in  the  progress  of 
medicine  it  will  become  possible  to  introduce 
into  the  economy  a  molecular  mechanism 
which,  like  a  very  cunningly-contrived  torpedo, 
shall  find  its  way  to  some  particular  group  of 
living  elements,  and  cause  an  explosion  among 
them,  leaving  the  rest  untouched. — Michigan 
Medical  News. 


In  1851,  when  the  population  of  Glasgow 
was  255,000,  the  number  of  practitioners  in  the 
city  was  231  ;  in  1861  the  population  was 
329,000,  but  the  number  of  practitioners  had 
falkn  to  226  ;  in  1871  the  population  was 
477,000,  while  the  practitioners  numbered 
again  231  ;  and  in  1881,  when  the  population 
of  the  city  had  increased  to  511,000,  the  prac- 
titioners are  found  to  number  only  294.  While 
our  population  has  almost  exactly  doubled, 
therefore  the  number  of  medical  men  has  in- 
creased only  by  about  sixty.  Dr.  Buchanan 
professed  his  inability  to  account  for  this  state 
of  matters  ;  but  at  least  three  explanations  sug- 
gest themselves.  In  the  first  place,  Glasgow  is 
undoubtedly  a  much  healthier  city  now  than  it 
was  thirty  years  ago,  and  consequently  supports 
the  medical  profession  less  liberally  ;  secondly, 


OF  MEDICAL  SCIENCE. 


71 


our  means  of  locomotion  are  so  much  improved 
that  men  undertake  much  larger  practices  now 
than  formerly;  and,  thirdly,  and  this  is  by  far 
the  most  important  reason,  should  be  mentioned 
the  shameful  and  growing  abuse  of  hospital  and 
dispensary  aid  which  goes  on  unchecked  in  this 
city. — London  Lancet. 


Medical  -Esthetics. — The  following  from 
the  Medical  Record  is  being  much  pi&sed  from 
hand  to  hand  in  New  York.  It  purports  to  be 
from  the  opera  of  '*  Patience." — 

A  New  York  medical  man, 

A  very  much  advertised  man, 
A  pills-in-variety,  talk  in  society, 

Each  for  himself  young  man. 

A  Philadelphia  man. 

An  Index  Medicus  man, 
A  think-it-all-gammon,  this  talk  of  Buchanan, 

Great-medical-centre  young  man. 

A  Boston  medical  man, 

A  hyper-historical  man, 
An  ultra-persimmon  toward  medical  woman, 

A  Harvard-or-nothing  young  man. 

A  Chicago  medical  man, 

A  wide-awake,  ethical  man, 
A  good-as-the-rest-of-you,  more-than-abreast-of-you. 

Down-on-the-East  young  man.  J. 

A  Toronto  medical  man, 

A  money  grub,  get  all  you  can, 
A  societies  shirker,  night  and  day  worker. 

Stick-in-the-mud  young  man. 


Quackery,  Ancient  and  Modern. — At  the 
Metropolitan  Counties  Branch,  Sir  Joseph 
Fayrer,  M.D.,  K.C.S.I.,  in  the  chair,  Mr.  Nel- 
son Hardy  read  this  paper.  He  said 
quackery  had  existed  from  time  immemorial, 
and  would  probably  continue  to  the  end  of 
time.  Perhaps  the  most  ancient  form,  the 
most  respectable  and  successful  one,  and  that 
which  longest  held  its  grasp  on  the  human 
mind,  was  astrology — the  most  sublime  and 
imposing  of  impostures — the  most  venial,  in 
some  respects,  of  delusions.  Having  traced 
the  manner  in  which,  in  the  earliest  times,  this 
typical  form  of  quackery  arose  and  grew, 
taking  its  origin,  like  other  forms,  as  the  result 
of  vague  experiences,  of  the  misleading  use  of 
signs,  and  of  the  liberal  use  of  the  post  hoc, 
ergo  propter  hoc  fallacy,  he  quoted  some  lines 


from    Chaucer    to    show     that,    in   his    time, 
astrology    was     practised     by    the    eminently 
respectable  doctor  of  physic  who  was  described 
in   the    Canterbury  Tales.      So   long   did    the 
belief  in  it  continue,  that  Richelieu  is  stated 
by  M.  Andrien  to  have  had   the  hoioscope  of 
Louis  XIV.  cast  at  the  moment  of  his  birth  ; 
and  there  could  not  be  any  doubt  that  many 
honest    and    well-informed   individuals   might 
have  been  found  amongst  those  who  practised 
it.     AiioLhcr    fox'm   of   imposture,   which    was 
practised  by  many  doubtless  honest  and  well- 
informed  medical  men,  during  the  time  that  it 
was    patronised    by   the   rich    and  great,  was 
alchemy,    which    bore   the    same    relation   to 
chemistry  that  astrology  did  to  astronomy — 
the  one  a  false  science,  the  other  a  true  one  ; 
the  false  believed  in,  caressed,  and  patronised 
by  monarchs  and  ministers  of  State ;  the  true 
having   to  battle    hard   for    bare  existence  in 
opposition  to   its  rival.     It  vas  important  to 
remember  how    long,  in    each  case,   thv^    false 
science  impeded  the  development  of  the  true ; 
and  how,  as  astronomy  and  chemistry  rose  to 
the  dignity  of  sciences,  they  shook  oflF  all  con- 
nection, not  only  with  impudent  pretenders  to, 
but   also    with  honest  believers  in,  astrology 
and  alchemy.     Among  modern  forms  of  quack- 
ery, homoeopathy,  mud-bath  cures,  milk-cures, 
and    whey-cures,    deserved   to   be   mentioned. 
Homoeopathy    stood  first,  as   Holloway's  pills 
and   ointment   did  among   quack  medicines — 
not,  he  thought,  from  any  intrinsic  merit  in  it 
above   the  other  forms  of  quackery,  except  it 
were  its   greater  adaptability  to  all  classes  of 
the    population    (mostly   fools,    according    to 
Carlyle)  everywhere  ;  unlike  hydropathy,  which 
required  splendid  hotel-buildings  and  beautiful 
scenery  to  carry  its  cures  to  perfection  ;  or  the 
mud-bath  system,  which  could  only  be  carried 
out  in  certain  continental  towns,  the  monstrous 
system  of  pretending  to  cure   serious  diseases 
by  globules  without  taste  or  smell,  or  appreci- 
able effect  of  any  kind   on  the  human  body, 
could  be  carried  out  in  every  house,  by  rich 
and  poor,  learned  and  unlearned,  and   better 
probably  by  those  who  knew  nothing  of  scien- 
tific medicine,  than  by  the  ablest  M.D.  of  Lon- 
don University.     Having  referred  to  the  adver- 
tisements of  quack  medicines,  and   quoted   a 


72 


CANADIAN  JOURNAL  OF  MEDICAL  SCIENCE. 


humorous  description  of  one,  Mr.  Hardy  for- 
mulated tliP  following  propositions.  \.  Quack- 
ery is  more  profitable  pecuniarily  than  scientific 
medicine,  but  not  so  profitable  mentally  or 
morally.  2.  Quackery  most  readily  finds  its 
victims  among  the  highest  and  lowest  social 
strata,  not  amongst  the  more  intelligent  middle 
classes ;  readily  also  amongst  religious  people — 
hence  certain  quacks  always  advertise  largely 
in  the  (so-called)  religious  periodicals.  3. 
Various  forms  of  quackery  have,  in  former 
times,  been  intimately  connected  with  the 
practice  of  medicine ;  but  they  have  always 
impeded  its  scientific  progress.  If  the  members 
present  agreed  with  him  on  these  three  points, 
they  would  have  no  difliculty,  he  thought,  in 
arriving  at  the  same  conclusion  that  he  had — 
viz.  :  that  it  was  the  bounden  duty  of  every 
honest  practitioner,  by  every  means  in  his 
power,  to  discourage  and  discountenance  all 
forms  of  quackery,  however  profitable  or 
plausible,  and  whether  practised  by  those 
within  or  without  the  profession.  Dr,  Dowse 
said  he  was  somewhat  disappointed  at  not 
hearing  more  about  the  modern  forms  of 
quackery.  He  thought  some  reference  might 
have  been  made  to  the  sly  advertising  which 
was  done  by  members  of  the  profession.  He 
would  like,  too,  to  have  a  definition  of  a  quack. 
The  writer  of  the  paper  had  been,  he  thought^ 
too  sarcastic  with  reference  to  certain  forms  of 
cures.  It  did  not  matter  whether  it  was 
homoeopathy  or  mud-baths  that  cured  those 
who  came  to  medical  men.  They  wanted  to 
be  cured ;'  and  scientific  medicine  too  often 
overlooks  the  most  important  part  of  its  work 
— therapeutics.  Science  did  not  do  much  for 
the  treatment  of  disease.  So  long  as  they 
cured  their  patient*,  and  did  not  resort  to 
villany,  medical  men  were  perfectly  at  liberty 
to  resort  to  any  system  whatever.  Dr.  Ilifi" 
agreed  that  the  great  point  was  how  to  cure 
patients.  He  thought  the  bone-setters  had 
taught  the  profession  a  great  deal.  The  water- 
cure  had  been  spoken  of  somewhat  contempt- 
uously ;  but  he  thought  hydropathic  establish- 
ments were  great  benefits.  Faith  had  great 
influence  in  the  treatment  of  disease.  He 
remembered,  when  a  student  at  Guy's  Hospital 
many    years    ago,    he    cupped  and    bled   one 


hundred  and  fifty  patients  in  three  months, 
simply  because  it  was  the  fashion  at  the  time. 
Mr.  Harwell  thought  quackery  rather  con- 
sisted in  the  manner  in  which  a  thing  was 
done,  than  in  the  thing  itself.  Any  one  who 
deceived  another  for  his  own  pocket  advantage 
was  a  quack  j  but  the  man  who  believed  in  the 
decillionth  of  a  grain  was  not  a  quack,  he  was 
a  lunatic.  The  Chairman,  though  he  confessed 
he  had  not  previously  paid  much  attention  to 
tht  subject,  was  inclined  to  agree  with  Mr. 
Barwell  as  to  the  definition  of  a  quack.  It 
was  certainly  very  curious  to  look  back  upon 
the  connection,  to  which  attention  had  been 
directed  in  the  paper,  between  astrology  and 
alchemy  on  the  one  hand,  and  astronomy  and 
chemistry  on  the  other.  Mr.  Hardy,  in  reply, 
said  he  agreed  with  the  chairman  and  Mr. 
Barwell,  that  a  medical  man  who  deceived  his 
patient  as  to  his  treatment,  lor  his  own  pocket 
advantage,  was  a  quack.  He  could  not  agree 
with  Dr.  Dowse  or  Dr.  Ilifi",  that  it  was  a 
matter  of  indifierence  what  system  was  adopted, 
so  long  as  the  patient  was  cured.  He  believed 
many  people  were  cured  who  took  Holloway's 
pills  and  ointment,  but  that  did  not  make  it 
any  the  less  quackery.  Dame  Nature  was  very 
kind  to  all.  But  he  believed  there  was,  never- 
theless, such  a  thing  as  scientific  treatment  of 
disease,  founded  upon  a  knowledge  of  anatomy 
and  physiology  ;  and  that  all  else  was  quackery. 
— Britith  Medical  Journal. 


givtUisi,  ^Warriiiocsi,  mil  ^ath^, 

MAEKIAGES. 

By  the  Rev.  D.  C.  McDowell,  of  Bownianville,  on 
the  28th  Dec,  at  the  residence  of  the  bride's  father, 
12  Charles  street,  Dr.  Jerrokl  Ball,  to  Emily,  daughter 
of  Frederick  A.  Moore,  Esq. ,  all  of  Toronto. 

At  St.  John's  Church,  Ancaster,  on  December  26th, 
by  the  Rev.  W.  R.  Clark,  Dr.  Stevenson,  of  Bradford, 
Ont.,  to  Helen  L.  M.,  eldest  daughter  of  Araiiger  J. 
Hubbard,  Esq.,  of  Brundale,  Ancaster. 

At  Emerson,  Man. ,  on  28th  December,  by  the  Rev. 
C.  J.  Brenton,  M.A.,  Dr.  .John  Smith,  of  Winnipeg, 
Man.,  to  Laura  Lillian,  only  daughter  of  the  late  John 
McLeod,  M.P.P.,  of  Dun  vegan,  Bowmanville,  Ont. 


On  the  inoming  of  the  11th  January,  at  Grand  Haven, 
Michigan,  Dr.  A.  J.  Whitehead,  aged  29  years. 

On  the  15tli  January,  at  the  residence  of  his  son,  Dr. 
Cannilf,  Jonas  Canniff,  aged  92  years. 

At  Cobourg,  on  the  17th  January,  James  Pringle, 
M.D.,  in  his  85th  year. 


TH  E 


Canadian  MmxMl  of 


1^ 
mtt 


A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


D.  OGDEN,  M.D., 

R.  ZIMMERMAN,  H.D.,  L.R.C.P.,  Lond., 


)  /,       7,-      pj*^,      I        A-  H.  WRIGHT,  B.A.,  M.B.,  M.R.C.S.,  Eng., )  Editors 
}Con^U^ngM^tors.     \         j.  „.  CAMERON,  M.B.,  ^lEdUors. 


SUBSCRIPTION,   «3    PER   ANNCM. 


aS"  All  literary  oommunioations  and  Exchanges  should  be  addressed  to  Dr.  CAMERON,  28  Gerrard  St.  East. 
SS"  All  business  oommunioations  and  remittances  should  be  addressed  to  Dr.  WRIGHT,  312  JarviB  Street. 


TORONTO,  MARCH,  1882, 


Anginal  (K<rmmnnwati0n;si. 

NOTES  ON  THERAPEUTICS  AND 
PHARMACOLOGY. 

BY  R.  L.  MACUONNELL,  B.A.,  M.D.,  M.R.C.S., 

(Assistant  Demonstrator  of  Anatomy,  McGill  Univer- 
sity, Montreal,  Physician  to  Montreal  Dispensary. ) 

PELLETIERINE  IN  TAPE-WORM. 

In  my  last  contribution  I  made  mention  of 
the  uses  of  Pelletierine  in  the  treatment  of 
tape-worm.  I  have  since  ascertained  through 
the  kindness  of  Mr.  H.  Grey,  Pharmaceutical 
Chemist,  of  this  city,  that  the  great  drawback 
to  it  is  its  costliness,  which  is  so  great  (20 
cents  per  grain)  that  at  present  its  use  is  almost 
out  of  the  question,  the  dose  being  a  gramme 
to  a  gramme  and  a  half.  The  fluid  extract  of 
pomegranate,  as  made  in  the  United  States, 
(Parke,  Davis  &  Co.)  is,  however,  said  to  be 
quite  as  efiective  as  the  alkaloid,  and  its  price 
is  within  the  reach  of  all. 

INFANT   FEEDING. 

One  of  the  troubles  of  a  young  practitioner 
(experto  crede)  is  the  management  of  infants, 
more  especially  of  infants  deprived  of  the 
natural  milk  supply.  The  Practitioner  of  June, 
1881,  reprints  a  little  leaflet  on  this  subject  by 
Dr.  Elliott,  of  the  Bristol  Hospital  for  Sick 
Children,  and  I  venture  to  abstract  some  of 
the  more  useful  hints  there  found.  After  the 
age  of  six  months  the  chief  difficulty  arises, 
and  the  following  foods  are  suggested.  1.  Boil 
the  crumb  of  bread  for  two  hours  in  water, 
taking  care  it  does  not  burn ;  then  add  a  lump 
of  sugar,  a  pinch  of  salt,  and  pour  a  little  new 
milk  upon  it  while  boiling  hot.  2.  Cut  thin 
slices  of  bread  into  a  basin,  cover  the  bread 


with  cold  water,  place  in  an  oven  to  bake ; 
when  sufficiently  baked  take  it  out,  beat  the 
bread  up  with  the  fork,  slightly  sweeten  and 
pour  on  milk.  3.  Baked  flour.  Bake  some 
biscuit  flour  in  a  slow  oven  until  it  is  of  a  light 
fawn  colour  ;  reduce  it  with  a  rolling  pin  to  a 
fine  powder,  and  keep  it  in  a  tin  ready  for  use. 
Two  tablespoonfuls  to  half  a  pint  of  milk 
boiled  and  sweetened.  4.  Boil  a  teaspoonful  of 
powdered  barley  (ground  in  a  cofiee  mill)  with 
a  little  salt  in  half  a  pint  of  water  for  fifteen 
minutes  ;  strain,  mix  with  half  as  much  boiled 
milk,  and  add  a  lump  of  sugar.  5.  Scotch 
oatmeal.  Prepare  in  the  same  way  as  4.  This 
food  is  especially  useful  for  regulating  the 
bowels  when  they  have  a  tendency  to  become 
constipated.  6.  Robb's  biscuits.  7.  Ridge's 
or  Neaves'  farinaceous  food  for  infants.  8. 
Revalenta  Arabica,  or  lentil  food.  9.  Cad- 
bury's  cocoa  essence,  Fry's  cocoa  powder,  or 
cocoa  nibs.  Dissolve  a  teaspoonful  of  either  of 
the  two  first  in  half  a  pint  of  boiling  milk  and 
water  (equal  parts) :  of  the  nibs  take  one  ounce 
and  boil  it  in  a  pint  and  a  half  of  water  for 
five  hours,  strain  and  add  new  milk  and  sugar. 
Cocoa  makes  an  excellent  food  for  thin  and 
wasted  infants,  who  take  it  greedily  and  soon 
improve  in  health. 

These  foods  are  to  be  given  lukewarm  through 
a  nursing  bottle.  In  hot  weather  test  the  food 
with  a  small  strip  of  litmus  paper.  If  the 
paper  turns  red,  make  a  fresh  mess,  or  add  a 
small  pinch  of  baking  soda  to  the  food. 

EFFECT  OF  DRUGS  IN  LACTATION. 

Another  point  to  which  the  practitioner's 
attention  must  be  directed  is  the  safety  of 
giving  powerful  medicines  to  women  who  are 


74 


CANADIAN  JOURNAL 


nuraing.  Mr.  Dolan  has  written  an  admirable 
essay  upon  this  subject,  which  was  sent  to 
America  in  competition  for  the  Boj'lston  prize. 
Most  unfortunately  the  publication  of  part  of 
it  in  the  Practitioner,  previous  to  the  award, 
deprived  the  author  of  his  prize.  I  shall 
merely  give  a  very  brief  synopsis  of  the  results 
of  his  observations. 

Aconite. — Two  minims  of  the  Linctuie  were 
given  every  half  hour  to  a  nursing  woman. 
After  twelve  minims  the  milk  was  drawn  oflf. 
No  trace  in  the  milk.  Still  Mr.  Dolan  thinks 
that  caution  ought  to  be  exercised  in  adminis- 
tering this  drug  to  nursing  mothers. 

Anise. — (Aqua  et  Oleum). — Said  to  promote 
the  secretion  of  milk.  It  merely  fl:ivoura  it 
and  renders  it  palatable  to  the  child. 

Anethum. — (Aqua  et  Oleum). — Dill  as  a 
galactogogue  is  useless.  Imparts  an  aromatic 
flavour  to  the  secretion.  It  may  be  given  to  a 
mother  whose  child  is  troubled  with  flatulent 
colic  after  sucking. 

Arsenic. — In  several  patients  with  cutaneous 
diseases,  chiefly  of  a  syphilitic  chai-acter,  it 
was  given  in  the  form  of  liq.  arsenicalis.  The 
children  were  weaned,  the  secretion  maintained 
by  artificial  suction,  and  the  milk  thrown 
away.  The  experiments  showed  that  arsenic 
had  passed  into  the  milk. 

Carbonate  of  Ammonia. — Found  in  the  milk. 

Acetate  of  Atmnonia. — Copious  diaphoresis. 
Secretion  of  milk  more  plentiful,  breasts  more 
distended.  On  examination  it  was  found  to  be 
thin,  poor,  and  watery.  So  that  somewhat  like 
jaborandi  this  drug  increased  the  water  in  the 
milk  without  improving  the  quality. 

Belladonna. — The  writer  endorses  Ringer's 
opinions  as  to  its  great  efl"pct  in  sui>pre.saing 
the  secretion  of  milk  (a  drachm  of  the  tincture 
to  an  ounce  of  olive  oil  ruV»bed  over  the  breast). 
Even  in  mam  nary  inflammation,  when  the 
breasts  are  tense,  shiny,  hard,  knotty,  red,  and 
exquisitely  painful,  the  continuous  application 
of  belladonna  for  twenty-four  or  forty-eight 
hours  will,  even  under  these  adverse  circum- 
stances, often  remove  the  tension  and  inflam- 
mation, and  arrest  impending  abscess. 

Is  it  to  be  found  in  the  milk  when  prescibed 
for  other  reasons  than  the  arrest  of  milk  ?  Is 
it  dau' eroub  to  the  child  1 


Observation  I. — After  three  doses  of  succus 
belladonure,  twenty  minims  each,  repeated 
every  four  hours,  no  trace  was  found  in  the  milk. 

Observation  II. — Thirty  minims  of  guccus 
every  four  hours  for  two  doses.  Quantity  of 
milk  unafiected,  with  no  trace  on  examination, 

III  these  two  cases  no  doubt  the  belladonna 
had  been  eliminated  by  the  kidneys. 

Copaiba.  — In  four  liouis  after  a  dose  ol 
copaiba  and  potash  mixture  the  urine  was  ex- 
amined. 1,  Odour  of  copaiba,  2,  Milk 
globules  made  larger  and  coarser.  3,  Answered 
the  nitric  acid  test.  The  child  would  not  touch 
the  breast.  Some  of  the  milk  drawn  ofi"  was 
given  to  a  child  two  years  old,  whose  urine 
half  an  hour  after  the  dose  was  found  to  have 
distinct  traces  of  copaiba  in  it. 

Chloral  Hydrate. — It  is  cumulative,  and 
sudden  deaths  occur  from  its  use.  In  par- 
turition, very  large  doses  are  sometimes  given, 
especially  in  puerperal  convulsions.  In  one 
case  there  was  no  trace  of  it  found  in  the  milk 
on  the  third  day  after  75  grains  had  been  taken 
in  doses  of  fifteen  grains  every  four  hours. 

Cod-liver  Oil. — No  effect  whatever  was  pro- 
duced on  the  milk  by  doses  of  half  an  ounce 
three  times  daily. 

Castor  Oil. — In  plethora,  when  the  secretion 
is  deficient,  it  is  most  useful ;  and  the  leaves 
of  the  plant  will  be  found  of  great  benefit  ap- 
plied as  a  cataplasm.  When  taken  by  the 
mother  it  is  found  to  have  a  purgative  action 
upon  the  child ;  the  mother's  milk  having  the 
taste  and  flavour  of  castor  oil. 

Digitalis. — In  three  cases  infusion  of  digitalis 
in  half  ounce  doses  was  given  every  six  hours. 
None  found  in  the  milk. 

Iodide  of  Potash. — Not  an  anti-lactescent  as 
reported. 

Mercury  has  been  found  in  the  milk,  but  in 
two  experiments  INIr.  Dolan  failed  to  find  any. 

Opium. — When  the  dose  is  large  the  narcotic 
principle  can  be  detected  in  milk,  but  in  small 
doses  no  trace  can  be  found. 

A  hdy  was  in  the  habit  of  using  the  tincture 
for  sleeplessness.  Usual  dose  was  20  or  30 
minims.  When  the  child  was  fed  it  slept  the 
whole  night  without  disturbing  her.  Her  in- 
fant was  pallid  and  listless.  The  milk  responded 
to  the  morphia  test. 


OF  MEDICAL  SCIENCE. 


75- 


Quinine. —  Three    grains  every    hour    were 

given  to  Alice  W .     After  twelve  grains 

had  been  taken  no  traces  were  found  in  the 
milk. 

Sulphur. — Even  when  used  for  scabies  has 
no  effect  upon  the  milk. 

Sulphur  and  senna  given  together  to  the 
mother  mildly  purge  the  child. 

Turpentine.-  -The  milk  had  a  strong  odour, 
but  was  not  otherwise  altered,  and  when  the 
child  was  put  to  the  breast  it  sucked  with 
avidity.  The  effect  of  the  turpentine  was 
noted  in  the  infant's  urine. 

In  an  exhaustive  article  on  the  same  subject 
in  the  January  number  of  Ziemssen's  Deutsches 
Archivfiir  Klin.  Med.,  Dr.  Stumpf's  conclusions 
are  as  follows  : — 

(A)  Changes  in  the  quantity  of  the  milk. 

1.  Iodide  of  potassium  materially  reduces  it. 
2.  Alcohol,  morphia,  and  lead  induce  no 
change.  3.  Salicylic  acid  appears  somewhat  to 
increase  it.  4.  Pilocarpin  does  not  augment 
the  amount. 

(B)  Changes  in  the  quality. 

1.  Iodide  of  potash  disturbs  the  function  of 
the  glands,  and  weakens  all  the  constituents  of 
the  milk.  2.  Alcohol  and  alcoholic  beverages 
cause  a  relative  increase  in  the  fatty  ingredients, 
but  are  to  be  condemned  as  means  for  increasing 
the  milk  supply.  3.  Lead,  morphia,  and 
pilocarpin  do  not  alter  the  quality.  4.  Salicylic 
acid  appears  to  increase  the  saccharine  matter. 

(C)  Passage  of  medicinal  agents  into  the 
milk. 

L  Iodide  of  potassium  passes  into  the  milk 
rapidly.  It  appears  to  be  in  some  way  con- 
nected with  the  casein,  and  not  to  be  in  solution. 
2.  In  herbivora,  alcohol  does  not  pass  into  the 
milk.  3.  Lead,  when  administered  in  small 
amounts,  is  met  with  in  traces  in  the  milk,  and 
continues  a  short  time  after  the  medicine  has 
been  taken.  4.  Salicylic  acid,  in  large  doses,  is 
met  with  in  small  quantities  in  the  human 
milk  in  larger  amounts  than  in  that  of  her- 
bivora. 

TREATMENT   OP   WHOOPING-COUGH. 

In  your  January  number,  Mr,  Editor,  you 
quote  from  the  Edinburgh  Medical  Journal, 
Dr.  Macdonald's  article  on  the  use  of  carbolic 
acid  in  whooping-cough.     Dr.  R.  W.  Powell, 


of  Ottawa,  in  an  article  in  the  March  number 
of  the  Canada  Medical  and  Surgical  J<mrrwl 
of  1880,  published  a  paper  on  this  very  sub- 
ject. He  found  that  the  average  number  of 
days  necessary  for  cure  in  the  successful  cases 
is  8.1 ;  also  that  the  percentage  of  failures  in 
13  cases  amounts  to  15.3. 

Prof.  J.  L.  O.  Heubner  estimates  the  relative 
value  of  five  pi'ominent  remedies  for  whooping- 
cough,  viz.:  salicylic  acid  (inhaled  as  a  spray  in 
a  one-third  to  one-half  per  cent,  solution), 
chloral,  belladonna,  quinine,  and  bromide  of 
potash.  From  his  results  it  appears  that  the 
best  remedy  for  influencing  the  frequency  and 
severity  of  the  attacks,  is  the  salicylic  inhala- 
tion, while  belladonna  has  the  greatest  influ- 
ence in  shortening  the  disease. — (Med.  Times, 
Dec.  31st,  1881.) 

GRINDELIA    ROBUSTA    IN   ASTHMA. 

Dr.  Rochester's  paper  on  the  treatment  of 
Asthma,  read  before  the  King's  County  Medical 
Society  of  Brooklyn,  is  noticed  in  the  Londdn 
Medical  Record,  and  commented  on  by  Dr. 
William  Murrell  in  the  October  number.  The 
results  of  60  cases  were  given.  It  was  of 
benefit  in  cases  of  a  spasmodic  as  well  as  of  a 
bronchial  kind.  It  may  be  given  either  in 
half-drachm  doses  of  the  fluid  extract  every 
quarter  of  an  hour  during  the  attack,  until 
the  paroxysm  subsides,  or  in  from  15  to  20 
drop  doses  in  the  intervals.  Dr.  Murrell 
thinks  that  grindelia  robusta  is  undoubtedly  a 
valuable  remedy,  and  succeeds  admirably  in 
some  cases  of  asthma,  although  in  others  it  sig- 
nally fails.  The  liquid  extract  of  Parke,  Davis 
&  Co.  is  said  to  be  a  reliable  preparation.  In 
a  case  of  asthma,  which  for  the  last  two  years 
has  been  under  constant  observation,  it  afforded 
relief  after  the  failure  of  many  remedies, 
including  arsenic,  belladonna,  ipecacuanha, 
lobelia,  iodide  of  potassium  in  half-drachm 
doses  four  times  a  day,  citrate  of  caffein, 
jaborandi  and  pilocarpin,  Jamaica  dogwood, 
quebracho  and  its  alkaloid,  nitrite  of  amyl, 
nitro  glycerin,  iodide  of  ethyl,  pure  terebene, 
hypodermic  injection  of  atropia  and  morphia, 
stramonium  and  datura  tatula,  r.itre  papers, 
cubebs  cigarettes,  vapo-cresolene,  blistera  over 
the  pneumogastrics,  and  liniments,  sprays  and 
inhalations  of  all  kinds. 


76 


CANADIAN  JOURNAL 


The  editor  of  the  Therapeutic  Gazette  (Dec, 
1881)  states  that  this  remedy  enjoyed  a  high 
reputation  among  the  Spanish  residents  of  the 
Pacific  States  as  a  rt^medy  for  bronchial  affec- 
tions, and  that  it  was  first  used  in  asthma 
by  Dr.  Ayres,  of  San  Francisco  in  1866.  He 
thinks  that  it  is  useful  merely  in  uncomplicated 
cases,  e.g.,  in  spasmodic  asthma,  but  that  in 
cases  depending  on  or  aggravated  by  bronchitis 
it  enters  as  a  very  efficient  agent  in  com- 
bination with  remedies  directed  to  the  relief 
of  the  complication.     Thus, 

R  Ext.  grindelise  robustse  fluidi 3i. 

Ext.  belladonnse  fluidi     5i^. 

Potassii  iodidi 5ij. 

Potassii  bromidi 5iii. 

Syr.  pruni  Virginianae     5^"- 

Aquae  dest.  ad 5^"^' 

M.  Sig. — A  tablespoonful  three  times  a  day 

during  the  intervals  of  the  paroxysm. 

SALICIN    ANB    SALICYLATE    OF    SODA    IN 
RHEUMATISM. 

This  is  a  subject  which  cannot  fail  to 
interest  the  medical  practitioner.  Lately, 
some  new  articles  have  appeared  tending  to 
confirm  the  praise  bestowed  upon  these  com- 
pounds. Dr.  Sydney  Coupland,  Physician  to 
the  Middlesex  Hospital  [Lancet,  Jan,  7,  1882), 
gives  an  analysis  of  86  Ciises,  of  which  4  were 
treated  partly  by  salicin  and  partly  by  other 
methods.  The  conclusions  arrived  at  are  as 
follows  : — 1.  In  the  majority  of  cases  salicylate 
of  soda  speedily  reduces  pyrexia  and  the 
articular  pain  of  acute  rheumatism.  2.  That 
unless  the  administration  be  long  continued, 
relapses  of  pyrexia  and  of  joint  affection  are 
liable  to  occur.  3.  That  such  relapses  are  not 
wholly  prevented  from  arising  during  the 
administration  of  the  drug,  and  that  in  some 
cases  they  are  distinctly  due  to  the  lack  of 
proper  precaution  in  matters  of  diet  and  rest, 
owing  to  the  freedom  from  acute  symptoms 
enjoyed  by  the  patient.  4.  That  the  best 
method  of  its  administration  is  in  regulated 
doses,  gradually  diminished  both  as  to  amount 
and  frequency.  5,  That  no  definite  influence 
upon  the  cardiac  or  other  comjilications  can  be 
observed,  and  that,  indeed,  both  pericarditis 
and  endocarditis  may  develop  whilst  the 
patient  is   under   its    influence.     6.  That  the 


toxic  effects  described  are  serious,  in  proportion 
to  the  largeness  of  the  dose,  aud,  perhaps, 
to  the  state  of  impurity  of  the  drug,  but  that 
a  few  seem  very  tolerant  of  it.  Its  alleged 
depressing  action  on  the  heart  has  to  be  proved 
by  experiment  a»d  may  be  due  to  the  soda. 
7.  Salicylate  of  soda  is  certainly  anti-pyretic, 
and  to  a  considerable  degree  anti-rheumatic. 
That  its  employment  does  not  appreciably 
diminish  the  time  necessary  to  keep  the  patient 
at  rest  more  than  under  other  methods  of 
treatment,  but  that  the  immense  relief  given 
by  its  use  in  the  abatement  of  pain  and  fever 
— a  relief  not  to  be  estimated  by  statistics — 
renders  it  by  far  the  most  valuable  remedy  for 
the  disease  at  present  known. 

Dr.  T.  J.  MacLagan  in  the  same  journal  con- 
tributes a  paper  on  this  subject  also,  or  rather 
the  editor  inserts  in  the  form  of  original 
matter  the  remarks  he  made  at  the  discussion 
of  the  Medical  Society  of  London  on  Dec. 
19th,  1881.  It  is  insisted  that,  to  obtain  good 
results,  large  doses  must  be  given.  The  larger 
the  quantity  that  can  be  thrown  into  the 
system,  the  more  rapid  will  be  the  destruction 
of  the  poison.  What  is  wanted  is  the  pres- 
ence in  the  blood  for  some  time  of  as  much 
of  this  anti-rheumatic  agency  as  can  well  be 
borne.  Of  the  salicyl  compounds,  practically* 
we  deal  only  with  salicin  and  salicylic  acid 
(generally  given  as  salicylate  of  soda).  Disas- 
trous results  have  been  recorded  from  the 
use  of  the  latter — delirium,  insanity,  prostra- 
tion of  the  vital  powers,  syncope,  and  even 
death.  Salicin  is  equally  powerful  as  an 
anti-rheumatic,  but  it  produces  none  of  the 
deleterious  effects  of  the  salicylates.  In  several 
cases,  some  of  which  he  has  recorded,  he  has 
given  full  doses  of  salicin  to  patients  suffering 
from  the  depressing  and  disturbing  action  of 
salicylate  of  soda;  and  under  its  use  (though, 
of  course,  not  in  consequence  of  it)  the  de- 
pressing effects  of  the  salicylate  have  disap- 
peared. As  to  relapses,  Dr.  MacLagan  thinks 
that  in  many  cases  they  are  due  to  the  too  early 
abandonment  of  the  salicyl  treatment,  and  also 
that  rheumatism  is  often  not  a  continued  but  a 
remittent  disease,  and  that  mild  cases  are 
but  the  natural  intermissions  of  the  disease. 
The    knowledge    that  the   symptoms    are   apt 


OF  MEDICAL  SCIENCE. 


77 


to  recur  is  a  reason  for  going  on  with  the 
salicyl  treatment  till  all  danger  of  an  inter- 
mission is  over.  Hyperpyrexia  is  regarded 
as  being  no  essential  part  of  the  rheumatic 
process,  but  as  peculiar  to  the  individual  in 
whom  it  occurs.  Salicyl  compounds  are  quite 
inoperative  in  it.  The  external  application  of 
cold  is  the  remedy  for  this  condition. 

TREATMENT    OF    OBSTINATE    HICCOUGH. 

A  writer  in  the  New  York  Medical  Record 
reports  success  by  the  administration  of  25 
grains  of  common  salt.  As  we  all  know  there 
are  very  many  remedies  used  in  this  distressing 
condition. 

Hipprocates'  aphorism,  "  Sneezing  coming 
upon  hiccough  cures  it,"  ought  to  give  us 
a  hint  as  to  treatment.  Since  I  noticed  this 
old  statement  I  have  not  had  an  opportunity 
of  testing  its  truth.  Perhaps  some  reader  of 
this  journal  may  make  a  note  of  it  and  report 
his  results. 

CODEIA    IN   DIABETES. 

A  paper  on  this  subject  was  read  before  the 
British  Medical  Association  by  Dr.  R. 
Shingleton  Smith  [British  Medical  Journal, 
Sept.,  1881,  p.  474).  It  is  stated  to  be  almost 
a  specific,  and  should  be  the  first  remedy  tried, 
being  given  in  fairly  large  doses  until  some 
physiological  efiect  is  produced.  Some  of  those 
present  stated  they  had  given  as  much  as  10  to 
15  grains,  thrice  a  day,  with  benefit,  and 
others  that  even  1  grain  a  d^y  had  caused 
unpleasant  symptoms.  It  was  suggested  that 
it  acted  on  the  medulla,  whence  the  original 
mischief  that  produces  diabetes  was  supposed 
to  spring.  This  speculation  is  favoured  by  the 
fact  that  codeia  is  valuable  in  cough. 

Dr.  Lauder  Brunton  advises  that  the  drug 
be  given  in  doses  of  a  quarter  to  half  a  grain 
three  times  a  day. 

HYPODERMIC    INJECTION   OF   WATER. 

This  question,  so  much  discussed  a  few  years 
ago,  is  again  brought  before  the  notice  of  the 
profession  by  a  Venezuelan  physician.  Dr. 
Ponte  {London  Medical  Record,  Nov.  15th, 
1881).  His  cases  were  intercostal  neuralgia, 
toothache,  gastro  intestinal  neuralgia,  <fec.  No 
doubt  the  good  effect  noted  in  these  cases  is 


due  to  the  efiect  of  the  puncture,  or  perhaps  to 
local  nerve-stretching  by  the  water.  In  cases 
where  there  is  really  severe  pain  this  plan 
I  have  myself  found  worthless.  I  tried  it 
in  a  case  of  abdominal  aneurism  encroaching 
on  the  lumbar  vertebrae.  The  fraud  was 
instantly  detected.  On  the  other  hand,  it 
answered  admirably  in  the  case  of  an  hysterical 
old  man  who  was  sufiering  from  cramps  in  the 
belly  after  an  apoplectic  seizure.  A  few  drops 
of  water  injected  into  the  arm  gave  great 
relief,  but  here  a  great  deal  of  the  pain  and 
irritability  was  due  to  bad  temper.  I  should 
like  to  hear  more  of  the  method  of  acu- 
puncture. It  seems  a  most  convenient  mode 
of  treating  lumbago  and  allied  afiections. 

ERGOTINE    IN   THE   NIGHT-SWEATS    OF    PHTHISIS. 

Professor  J.  M.  Da  Costa,  in  a  clinical 
lecture  delivered  at  the  Pennsylvania  Hospital, 
pronounces  ergotine  the  remedy  best  cal- 
culated to  relieve  this  troublesome  complication. 
Dr.  Da  Costa  finds  ergotine  possesses  some  of 
the  certainty  and  permanence  of  action  of 
atropia,  without  its  drawbacks.  The  dose 
is  usually  two  grains,  three  or  four  times  a 
day,  and  by  the  second  night  its  influence 
begins  to  be  manifested.  The  remedy  may 
then  be  continued,  and  gradually  abandoned ; 
it  produces  no  annoyance  whatever,  and  its 
good  effects  continue  after  it  has  been  with- 
drawn [London  Medical  Record,  Nov.,  1881). 


NECROSIS  OF  CRANIAL  BONES. 

(Clinical  Lecture  at  Toronto  General  Hospital,  Session 
1881-82.) 

BY   J.    THORBURN,    M.D.,    EDINBURGH, 

Sui^eon  to  the  Hospital,  Lecturer  on  Materia  Medica,  Toronto 

School  of  Medicine. 

Gentlemen, — The  case  before  you  is  one  of 
necrosis  of  the  bones  of  the  cranium.  Evi- 
dently the  parietals  are  very  extensively 
destroyed.  So  far  have  these  bones  succumbed 
to  the  process  of  decay  that  a  large  part  of  the 
vertex,  as  you  see,  is  gone,  the  membranes 
ex})Osed,  and  the  pulsations  of  the  brain  plainly 
seen.  It  is  seldom  that  we  see  such  an  exten- 
sive destruction  of  the  bony  covering  of  thQ 
brain.     Can  we  find  the  cause? 


78 


CANADIAN  JOIJRNAL 


In  order  to  this  I  will  give  you  the  history 
of  the  case. 

D.  M'C — ,  farmer,  aet.  G3,  admitted  to  Hospi- 
tal, October  22,  1?81.  Born  in  Scotland,  pre- 
sent abode  Orillia,  County  of  Simcoe,  Is  a 
single  man.  The  family  history  is  good.  No 
hereditary  predisposition  to  disease.  Patient 
has  used  stimulants  modex-ately,  tobacco  very 
immoderately. 

Previous  Diseases  or  Injuries. — Some  twent)  - 
five  years  ago  the  patient  sprained  his  back  in 
the  lumbar  region,  has  never  done  hard  wox-k 
since.  Has  been  troubled  by  indigestion  and 
general  weakness  for  last  twenty  years.  Some 
two  years  ago  got  stung  by  "  poison  ivy "  in 
the  head,  considerable  swelling  over  the  left 
side  and  vertex  resulting.  This  swelling  slow- 
ly disappeared  in  the  course  of  six  weeks  with- 
out treatment.  During  the  summer  he  was  in 
the  habit  of  sleeping  on  a  bedstead  too  short 
for  him,  and  on  waking  in  the  morning  would 
occasionally  find  his  head  sore  from  pressure. 
Also,  the  cellar  ceiling  was  low  and  he  occa- 
sionally struck  his  head  thereon.  Was  often 
exposed  to  the  possibility  of  syphilitic  con- 
tagion, but  denies  ever  having  had  syphilis. 

Present  Disease. — In  July,  1881,  after  work- 
ing one  day  in  the  hot  sun,  felt  as  though  he 
experienced  a  slight  sunstroke.  Two  weeks 
afterwards  severe  pains,  originating  in  the 
lower  occipital  region,  and  shooting  to  the 
vertex,  troubled  him  a  good  deal.  These 
gradually  increased  in  severity,  and  were 
always  aggravated  by  change  of  position. 
Afterwai'ds  was  troubled  with  twitching  of  the 
arms.  Apj)etite  became  very  poor,  and  after 
sufi'ering  in  this  way  for  some  weeks  swelling 
appeared  on  the  head,  when  he  came  to  the 
hospital. 

State  on  Admission. — Complained  much  of 
stifihess  of  neck  and  swelling  of  the  glands, 
and  it  was  for  this  chiefly  that  he  sought 
medical  advice  at  the  hospital.  Upon  examin- 
ing the  head  it  was  found  swollen  and  boggy 
over  the  vertex;  complained  of  little  or  no 
pain  in  the  scalp  at  this  time.  The  tumefac- 
tion was  such  as  to  lead  to  the  conviction  that 
disease  of  the  bone  or  periosteum  was  present. 

Respiration,  quiet ;  pulse,  80 ;  temperature, 
normal ;  digestion,  fair ;  bowels  rather  consti- 


pated. Treatment:  two  long  incisions  were 
made,  one  along  the  vertex  over  the  parietal 
region  ;  one  over  the  upper  part  of  the  occipital. 
Free  haemorrhage  occurred ;  the  bones  were 
found  denuded  of  periosteum  and  necrosed,  a 
probe  could  be  ])assed  to  the  dura  mater. 

Syr.  Ferri  lodidi  administered,  and  poultices 
applied  to  the  openings,  secured  in  place  by  a 
capelline  bandage. 

Nov.  15. — One  of  the  incisions  was  enlarged. 
At  this  time  the  cavity  over  the  vertex  was 
large,  portions  of  necrosed  bone  could  be  picked 
off  by  the  finger,  a  considerable  surface  of 
dura  mater  can  be  seen  ;  the  pulsations  of  the 
brain  are  plainly  visible. 

December  6th. — Eyes  examined.  Patient 
says  his  sight  has  been  failing  very  much  for 
past  two  years.  An  opacity  of  left  cornea  is 
present.  Pupils  dilatable,  but  extremely  con- 
tracted. Opacity  of  media  prevents  thorough 
ophthalmoscopic  examination,  but  a  large 
hgemorrhagic  patch  is  seen  in  left  fundus. 

December  10. — Microscopic  examination  was 
to-day  made  for  evidences  of  malignancy,  with 
negative  results.. 

Now,  gentlemen,  we  must  endeavour  to  find 
the  cause  of  this  death  of  bone ;  for  it  is  only 
by  finding  the  cause  in  such  cases  as  this  that 
we  can  be  sure  of  treating  them  properly.  The 
state  of  matters  you  see  before  you  may  have 
been  produced  in  various  ways, — the  various 
causes  requiring  entirely  difFerent  lines  of 
treatment;  therefore  the  question  becomes  of 
paramount  importance  to  the  patient, — can  we, 
by  the  most  careful  study  of  the  history  and 
condition  of  this  man,  unravel  the  difficulties 
which  seem  to  surround  the  case  1  for  a  casual 
examination  will  throw  little  light  upon  it;  the 
case  is  an  obscui'e  one,  and  demands  our  closest 
examination. 

The  condition  which  is  here  present  might 
be  the  result  of  several  causes  which  I  will 
enumerate. 

First, — It  may  be  due  to  some  form  of  car- 
cinoma. In  favour  of  this  supposition  we  have 
several  points  :  the  age  of  the  patient ;  the  ex- 
tensive destruction  of  bone,  and  the  enlarge- 
ment of  the  glands  of  the  neck,  all  give  a  pro- 
bability to  the  idea.  But  none  of  these  circum- 
stances is  to  be  held  as  pointing  absolutely  to 


OF  MEDICAL  SCIENCE. 


79 


malignancy,  they  are  all  susceptible  of  explana- 
tion on  another  hypothesis,  as  we  shall  pre- 
sently see.  So  it  will  be  advisable  to  give  the 
patient  the  benefit  of  the  doubt,  and,  if  we  can 
discover  any  other  probable  cause,  treat  him 
accordingly.  Again,  against  the  theory  of 
cancer,  we  may  put  the  absence  of  that  cachexia; 
and  the  further  fact  t  hat  a  most  careful  micros- 
copic examination  of  the  case,  by  one  of  my 
clinical  clerks,  failed  to  reveal  any  evidences  of 
this  form  of  disease.  If  not  malignant,  then, 
another  recognized  cause  of  the  death  of  bones 
is,— 

Second, — Struma.  Is  it  strumous?  It  cer- 
tainly may  be.  The  appearance  of  the  patient, 
the  extensive  destruction  of  bone,  the  obstinacy 
of  the  case,  are  all  in  harmony  with  this  theory. 

But  on  the  other  hand  it  may  be  pointed 
out,  that  in  struma  you  find  an  exceedingly 
light  and  oily  condition  of  the  affected  bone — 
characters  which  are  entirely  absent  here. 

We  proceed  now  to  consider  the  third  cause 
which  may  produce  this  condition,  namely, — 
Syphilis.  But  can  we  really  consider  this  as 
a  possible  cause  in  the  face  of  the  history  which 
we  have  heard  read]  In  it  there  is  no  history 
of  this  complaint.  The  patient  himself  abso- 
lutely denies  it.  With  the  exception  of  two 
small  copper  coloured  spots  on  the  leg,  an  un- 
cerbJiia  rash  which  appeared  on  his  body  years 
ago,  and  the  condition  of  tho  eyes,  there  are 
absolutely  no  indications  of  secondary  syphilis. 

But  we  must  consider  this  idea  fairly  within 
the  circle  of  probable  causes  when  we  remem- 
ber that,  althougli  entirely  denying  the  pre- 
sence of  syphilis  at  any  time  of  his  life,  he 
admits  having  frequently  exposed  himself  to 
the  risk  of  contagion. 

This  peculiar  loss  of  sight,  with  such  oph- 
thalmoscopic appearances  as  were  made  out, 
are  certainly  not  against  this  hypothesis.  And 
the  rash  on  the  abdomen  (probably  roseola), 
the  spots  on  the  leg,  the  condition  of  his  head 
after  the  poisoning,  are  all  confirmatory  points. 
And  the  present  state  of  the  patient  points  in 
this  direction.  The  bones  afi'ected  are  just 
those  we  expect  to  be  attacked  in  syphilis. 
The  destruction  is  extensive,  both  tables  are 
gone,  and  the  appeai-ance  is  what  we  would 
expect  in   the   breaking  down   of   gummata. 


The  enlargement  of  the  glands  of  the  region  is 
probably  due  to  one  of  two  causes — we  have, 
for  the  present,  set  aside  cancer— it  may  be 
due  to  syphilis.  Again,  in  tertiary  syphilis, 
the  tolerance  of  large  doses  of  pot.  iodid.  is 
remarkable, — the  good  efiects  resulting  are 
often  very  great.  Now,  although  it  is  too 
soon  to  speak  of  results  in  this  case,  we  can  at 
least  say  he  bears  large  doses  well,  in  fact,  I 
note  a  slight  improvement  since  this  drug 
began  to  be  exhibited. 

On  a  general  and  careful  review  of  all  the 
circumstances,  I  am  inclined  to  pronounce  this 
case  one  of  syphilitic  necrosis.  At  the  same 
time,  it  must  be  admitted,  that  the  difficulties 
of  arriving  at  a  tolerably  satisfactory  diagnosis 
are  exceedingly  great. 

The  prognosis  must  be  guarded.  The  con- 
dition of  the  patient  is  not  such  as  to  inspire 
hope.  But  if  the  improvement  now  noted 
under  anti-syphilitic  treatment  be  maintained 
for  the  next  few  weeks,  I  shall  have  reason  to 
anticipate  a  successful  issue. 

The  further  history  of  the  case  is  as  follows': 

January  10. — Previous  examinations  of  urine 
having  shown  absence  of  albumen  and  sugar, 
it  was  to-day  examined  microscopically.  A 
few  disintegrated  granular  cists  are  seen;  fatty 
degeneration  evidently  going  on  in  some  of 
them. 

Patient  has  been  going  about — in  a  weak 
and  listless  manner — through  the  day,  occasion- 
ally, up  to  this  time. 

January  12. — Pot.  iodid,  grs.  xx.  t.  i.  J, 
ordered  some  time  ago.  Some  improvement 
manifest. 

January  20. — Had  three  epileptiform  fits. 

January  24. — Has  been  confined  to  bed  for 
some  days.  Dorsal  decubitus  constant.  Semi- 
comatose. Respirations  quick  and  shallow, 
forty  per  minute.  Slight  cough.  Expectorates 
considerable  mucus  with  difficulty.  No  diffi- 
culty in  deglutition ;  no  pain,  paralysis,  or 
anaesthesia.  No  oedema  of  limbs,  but  slight 
puffiness  of  face ;  is  very  feverish. 

January  25. — Died  early  this  morning,  bav- 
in" had  no  remission  of  the  comatose  condition 
noted  yesterday. 

At  the  autopsy  made  the  same  day,  by  Dr. 
Sheard,  the  diagnosis  of  the  case  was  remark- 


80 


CANADIAN  JOURNAL 


ably  contirmed.  Extensive  necrosis  of  the 
parietal  bones  along  the  vertex,  of  the  upper 
part  of  the  frontal,  and  of  a  large  part  of  the 
occipital  was  found.  The  syphilitic  deposit 
was  found  to  have  occluded  the  periosteal 
vessels,  a  gradual  process  of  necrosis  of  the 
bone  below  consequently  resulting.  Along 
the  vertex,  under  the  remains  of  these  necrosed 
portions,  the  membranes  were  found  greatly 
thickened,  and  matted  together  by  the  exten- 
sive inflammatory  exudation  into  the  parts. 
The  thickened  mass  measured  superficially 
about  2^  by  3  inches,  and  was  at  least  one-half 
inch  thick  at  its  thickest  part.  Its  upper  sur- 
face was  covered  by  spicules  of  bony  matter, — 
the  debris  from  the  necrosed  bones  above. 
The  middle  meningeal  arteries  were  found 
to  be  totally  occluded,  this  condition  also 
being  due  to  the  syphilis. 

'The  case  was  considered,  from  its  patho- 
logical anatomy,  to  be  a  typical  one  of  syphilitic 
necrosis. 


CASE  OF  RUPTURE  OF  UTERUS. 

BY    L.    m'fARLANE,    M.B,, 

Surgeon  to  Toronto  General  Hospital  and  Home  for  Incurables ; 
Assistant  to  the  Chair,  and  Demonstrator  of  Anatomy,  Toronto 
School  of  Medicine. 

Mrs.  K — ,  aet.  26,  at  her  third  labour. 
Before  her  marriage,  five  years  ago,  she  had 
cough  and  haemoptysis,  which  lasted  for  five 
or  six  months.  The  first  two  labours  were 
normal  in  every  respect  and  the  getting  up 
satisfactory.  During  the  present  gestation  she 
complained  constantly  of  pain  in  the  left  iliac 
region,  and  on  one  or  two  occasions  there  was 
some  dyspareunia,  otherwise  her  health  has 
been  excellent.  One  or  two  weeks  before 
labour  set  in  there  was  a  little  coloured  dis- 
charge, which  ceased  on  lying  down,  but  which 
necessitated  the  use  of  a  napkin.  This  was 
succeeded  by  a  thick,  greenish  discharge,  which 
continued  until  the  commencement  of  labour. 
Pains  came  on  about  9  a.m.  of  Tuesday,  Feb.  7. 
She  ate  a  hearty  meal  about  noon.  At  3  p.m.  the 
pain  began  to  be  severe  and  expulsive,  and 
continued  until  about  a  quarter  to  six  o'clock. 
She  was  seen  about  a  quarter  past  six,  lying  on 
her  left  side,  spoke  rationally,  and  complained 
only  of  a  pain  about  the  fundus  uteri ;    said 


that  she  could  not  move  to  the  edge  of  the  bed 
on  account  of  the  severity  of  this  pain.  An 
examination  immediately  revealed  the  head 
well  down  in  the  pelvis  in  the  second  position. 
After  waiting  ten  or  fifteen  minutes  for  the 
recurrence  of  pains,  the  hand  was  passed  over 
the  abdomen  to  discover  the  source  of  the  con- 
stant pain  of  which  she  complained,  it  was  then 
noticed  that  she  was  very  pale,  the  radial 
pulse  was  wanting.  The  patient  then  com- 
plained of  feeling  very  weak  and  faint,  the 
pillows  were  removed ;  she  became  very  rest- 
less, some  brandy  was  administered.  Ex- 
claiming that  she  was  dying,  she  raised  herself 
on  her  hands  to  get  breath,  fell  over,  and 
within  five  minutes  was  dead. 

Autopsy  twenty  hours  after  death.  The 
body  was  that  of  a  well-nourished  woman. 
The  abdomen  protuberant;  on  palpation,  the 
foetus  could  be  felt  lying  obliquely  in  the  ab- 
domen, the  breech  well  up  under  the  ribs  on  the 
left  side.  A  firm  lump  could  also  be  felt  below 
and  to  the  right  of  the  umbilicus.  On  cutting 
down  to  the  peritoneum  t^e  cavity  was  found 
filled  with  bloody  fluid  and  some  clots.  The 
fundus  uteri  was  immediately  to  the  right  of 
the  umbilicus;  the  placenta  was  lying  in  the 
abdominal  cavity,  partially  extruded  through  a 
rent  in  the  uterus.  The  body  of  the  foetus  was 
lying  in  the  left  side  of  the  cavity,  the  head 
still  in  the  pelvis.  By  carefully  following 
down  the  rent  in  the  uterus  it  was  found  to 
extend  from  the  fundus  posterior  to  the  attach- 
ment of  the  left  broad  ligament  trending 
slightly  forwards  down  through  the  cervix. 
There  was  some  haemorrhage  between  the  folds 
of  the  broad  ligament,  and  the  peritoneal 
covering  of  the  uterus  was  to  a  slight  extent 
dissected  ofi"  by  blood.  The  rupture  extended 
through  the  site  of  the  placental  attachment. 
The  uterine  walls  were  slightly  thinner  and 
perhaps  softer  than  natural,  though  they  did 
not  tear  very  easily.  The  membranes  were 
adherent,  but  peeled  ofi",  somewhat  like  the 
capsule  of  a  granular  kidney.  The  left  ovary 
was  cystic  entirely,  and  about  the  size  of  a 
walnut;  the  right  ovary  normal,  and  in  it  was 
the  corpus  luteum.  The  bladder  was  full  of 
urine.  The  child  was  a  female,  of  fair  size, 
and  well  nourished.  About  two  quarts  of 
clots  and  bloody  fluid  were  sponged  out  of  the 
abdominal  cavity.  Microscope  showed  granular 
and  fatty  degeneration,  with  inflammatory 
exudation  in  neighbourhood  of  rent 


OF  MEDICAL  SCIENCE. 


81 


EPITHELIOMA    OF    TONGUE;    RE- 
MOVAL   BY   THE    GALY  A  NO- 
CAUTERY. 

BY   W.    T.    AIKINS,    M.D.,    LL.D., 

President ;  and  Lecturer  on  Surgery,  Toronto  School  of  Medicine, 
Surgeon  to  Toronto  General  Hospital,  Central  Prison,  etc. 

A.  R.,  set.  56,  Scotch,  tall,  spare,  living  at 
Woodstock.  Had  always  been  healthy  ;  was  a 
heavy  smoker  for  twcnty-five  years.  In  Feb., 
1881,  first  noticed  something  amiss  in  his 
tongue,  which  appeared  to  be  a  small  thicken- 
ing or  lump  on  its  left  side  near  the  base. 
"Was  under  the  care  of  Dr.  Welford,  who  soon 
pronounced  it  epithelioma,  and  advised  its 
removal. 

First  seen  by  Dr.  Aikins  in  October,  when 
he  found  an  ulcer  with  hard  everted  edges 
(evidently  an  epithelioma)  where  the  thicken- 
ing was  fii-st  noticed  by  the  patient,  and  decided 
to  operate  at  once.  On  the  22nd  of  October 
he  performed  the  operation  of  partial  excision  of 
the  tongue,  being  assisted  by  Drs.  Welford, 
and  W.  H.  Aikins.  Dr.  A.  H.  Wright  ad- 
ministering the  chloroform.  The  mouth  being 
kept  open  by  an  ordinary  gag,  he  removed  the 
posterior  two-thirds  on  the  left  side  with  the 
galvanic-cautery  wire.  The  incision  was  ex- 
tended into  the  pharynx  removing  a  large 
portion  of  the  anterior  pillar  of  the  fauces,  and 
every  care  was  taken  by  keeping  close  to  the 
jaw,  and  including  mucous  membrane  and  some 
sub-mucous  tissue  between  the  tongue  and  the 
jaw,  as  well  as  going  back  into  the  pharynx,  to 
leave  none  of  the  new  growth  remaining.  It 
was  suspected  that  one  or  two  of  the  glunds 
were  involved,  but  a  careful  examination 
showed  that  this  was  not  correct.  The  opera- 
tion was  tedious  (occupying  about  three  hours) 
and  it  was  found  very  difficult  to  get  well 
behind  the  giowth.  There  was  little  or  no 
bleeding  and  no  mishap  of  any  description. 

The  after-treatment  consisted  sim])ly  in  wash- 
ing the  mouth  with  carbolized  water.  The 
patient  was  kept  under  observation  by  Dr. 
Aikins  in  Toronto  for  six  days,  at  the  expira- 
tion of  which  he  went  home. 

Patient  again  seen  by  Dr.  Aikins,  February 
14:th,  1882,  nearly  four  months  after  the  opera- 
tion and  the  condition  of  his  mouth  was  found 
to  be  most  satisfactory  in  every  respect.     The 


wound  was  thoroughly  healed  and  looked  per- 
fectly healthy.  There  was  very  little  deformity 
considering  the  amount  of  tissue  removed,  and 
there  was  no  sign  of  any  recurrence  of  the 
growth  in  the  mouth  or  throat — no  enlargement 
of  the  glands — speech  but  little  impaired. 
The  patient  was  remarkably  well  in  every 
respect,  very  cheerful,  and  grateful. 


3t\uX\my,  p^didtt^. 


MORAL  INSANITY. 

Dr.  Savage  gives  a  vivid  and  interesting 
picture  of  that  obnoxious  form  of  cerebral 
disease,  moral  insanity.  The  American  public 
has  recently  had  opportunity  of  learning) 
through  the  newspapers,  the  views  of  certain 
well-known  alienists  who  have  disclaimed  belief 
in  the  existence  of  such  a  form  of  disease.  And 
yet  nothing  is  more  familiar  to  the  student  of 
insanity  than  alteration  of  the  moral  sentiments 
from  disease.  No  late  writer  on  the  subject, 
whose  opinion  is  worth  consulting,  has  failed  to 
recognize  the  existence  of  moral  insanity  as  a 
well-established  fact ;  while  perhaps  no  person 
is  capable  of  being  intellectually  complete  and 
morally  defective,  yet  the  intellectual  defect 
mav  be  so  slight  or  so  unimportant  that  it 
would  not  of  itself  cause  loss  of  self-control,  and 
may  be  practically  disregarded.  The  expert 
witness  who  denies  that  moral  insanity  exists, 
who,  in  the  face  of  such  careful  and  conclusive 
authorities  as  the  late  Dr.  Ray  and  many  others, 
declares  that  criminal  acts  are  always  criminal, 
that  kleptomania  is  always  stealing,  and 
dipsomania  is  always  drunkenness,  and  nothing 
more,  is  himself  in  danger  from  a  certain  un- 
wholesome self-conceit  that  might  itself  be 
likened  to  moral  insanity.  Such  obloquy  has 
been  thrown  on  scientific  authority  of  late,  as 
tending  to  shield  the  really  criminal  from 
punishment,  that  it  requires  a  peculiar  manliness 
to  concentrate  the  mind  on  the  truth,  and  give 
it  impartial  utterance,  without  allowing  sym- 
pathy for  the  criminal  or  j)rejudice  against  him 
to  warp  the  presentation.  Dr.  Savage  opens 
one  question  which,  fully  discussed  and  decided 
by  both  the  medical  and  the  legal  professions, 
would  do  much  to  bring  those  who  are  utterly 
at   variance   as   to  this  form   of  disease  into 


82 


CANADIAN  JOIJENAL 


harmony.  It  is,  whether  morally  insane 
patients  should  not  be  treated,  in  many  instances, 
where  crimes  have  been  committed,  in  an 
intermediate  manner,  neither  with  the  severity 
of  the  jail  (or  the  scaffold)  nor  with  the  com- 
parative luxury  of  the  asylum.  The  recognition 
ot  a  modified  responsibility,  by  reason  of  mental 
disease,  by  the  courts,  and  by  those  who  frame 
the  laws,  would  do  much  to  secure  an  efficient 
administration  of  justice.  To  the  obvious 
objection  that  it  would  be  difficuit  to  judge  of 
the  degree  of  responsibility  in  a  given  case,  it 
may  be  replied  that  a  court  of  justice  does  not 
assume  to  be  a  perfect  instrument,  but  only  to 
come  as  near  the  right  as  is  possible ;  and  in 
dealing  with  this  condition,  a  modified  or 
partial  responsibility,  it  would  not  be  grasping 
at  an  abstraction,  but  contemplating  a  fact ; 
for  no  one  conversant  with  the  insane  as  seen 
in  asylums  would  deny  that  many  of  them 
practice  self-control,  yield  to  and  resist 
temptation,  indulge  and  restrain  passion.  In 
fact,  tlie  key-note  of  successful  moral  treatment 
of  the  insane  is  the  endeavor  to  inaugurate  and 
cultivats  this  very  pivotal  function,  self-control. 
In  dealing,  then,  with  a  fact,  there  seems  to  be 
no  reason  why  a  court  should  not  arrive  at  as 
reasonably  j  list  a  result,  through  the  testimony 
of  those  who  are  familiar  with  disease,  as  by 
setting  up  the  wholly  erroneous  principle  that 
a  man  must  be  wholly  responsible,  unless  his 
mind  is  so  completely  overthrown  that  he  has 
no  glimmer  of  perception  of  right  and  wrong. 
The  rigbt-and-wrong  test  was  put  out  of  court 
by  the  most  eminent  justice  of  Massachusetts 
courts,  many  years  ago,  but  we  still  hear  the 
echo  of  it  in  the  deplorable  chaos  of  a  trial 
which  has  been  wearily  dragging  on  in 
Washington. — New  York  MedicalJoumal. 

Albumen  water  is  recommended  as  a  good 
substitute  for  milk  and  beef-tea,  in  cases  where 
these  substances  disagreed  with  the  patient,  or 
could  not  be  obtained.  The  preparation  is 
largely  used  by  the  French.  It  is  made  by 
dissolving  the  white  of  one  or  more  eggs  in  a 
pint  or  two  of  water,  sweetening  with  glycerine, 
and  flavouring  with  orange-flower  water.  It 
may  be  taken  cold  and  used  ad  libitum.  It  is 
an  excellent  food  in  typhoid  fever  and  typhoid 
dysentery. — Dublin  Jour,  of  Med.  Science, 
Sept.,  1881. — Medical  News. 


FELTZ  AND  RITTER,  ASTASCHEW- 
SKY,  AND  DEMJAKOW,  ON  THE 
PATHOLOGY  OF  URJEMIA. 

Feltz  and  Bitter  (Paris,  1881)  have  come  to 
the  conclusion,  on  the  basis  of  a  large  number  of 
experiments,  that  the  phenomena  of  ursemia 
are  due  to  the  accumulation  in  the  blood  of  the 
inorganic  constituents  of  the  urine,  especially 
the  potash  salts.  They  found  that,  in  animals 
whose  renal  arteries  were  tied,  the  longer  they 
lived  the  more  urea,  creatine,  and  ammonia 
were  found  in  the  blood ;  but  that  the  intro- 
duction of  these  salts  into  the  blood  of  animals 
whose  renal  arteries  had  been  ligatured,  did 
not  hasten  the  urseraic  symptoms,  while  the 
injection  of  fresh  urine  did.  This  was  not 
from  simple  increase  of  blood-pressure,  as 
similar  quantities  of  pure  or  acidulated  water 
gave  negative  results.  They  reckoned  the  quan- 
tities of  urea,  urates,  hippurates,  creatine,  crea- 
tinine, leucine,  tyrosine,  taurine,  anthine,  etc., 
which  would  be  formed  during  three  days  (the 
time  in  which  death  usually  followed  after  liga- 
ture), and  found  that  injection  of  this  quantity 
of  each  produced  no  effect.  The  same  negative 
results  followed  the  injection  of  the  ammonia 
derivate,  of  the  extractives,  urea,  and  urinary 
ferment,  also  chloride,  sulphate,  and  phosphate 
of  ammonia.  On  the  other  hand,  urine,  from 
which  the  organic  substances  and  earthy  salts 
were  removed,  was  rapidly  fatal,  and  was  so  in 
proportion  to  the  amount  of  potash  salts  con- 
tained in  it.  Also,  they  found  the  same  results 
from  the  injections  of  fluids  containing  potash ; 
for  example,  they  found  that  a  dog,  weighing 
15  kilogrammes,  was  killed  by  a  dose  of  chloride 
of  potassium  equal  to  two  decigrammes  per 
kilogramme  of  body  weight ;  others  were 
killed  by  10  to  15  centigrammes.  The  mini 
mum  dose  of  phosphate  of  potash  was  rather 
larger,  25  centigrammes  per  kilogramme.  With 
chemically  pure  solutions,  the  toxic  action  was 
still  more  marked  and  quicker.  The  soda  salts 
were  innocuous  in  doses  of  1  gramme  per  kilo- 
gramme. The  earthy  salts  were  so  equally. 
Finally,  an  increase  of  the  potash  salts  in  the 
blood  was  found  in  the  animals  dying  of 
ursemia  from  ligature  of  the  renal  vessels. 

Astaschewsky  (Petersburger  Med.  Woch.,  No. 
27,  1881)  had  independently  come  to  the  same 


OF  MEDICAL  SCIENCE. 


83 


conclusion  as  the  above.  He  found  no  effect 
from  urea  or  creatinine,  whilst  the  injection  of 
the  mineral  salts  of  the  urine,  in  amount  equal 
to  the  three  days*  equivalent,  caused  uraemia. 
When  the  potash  salts  were  Removed,  no  de- 
cided effect  followed. 

Demjakow  {Petershurger  Med.  Woch,,  No.  28) 
observed  a  ursemic  patient  with  a  strong  am- 
moniacal  odour.  He  injected  urea  and  fer- 
ment without  distinct  results,  until  he  used  the 
three  days'  equivalent.  Pure  urea  hastened 
the  ursemic  attacks  by  twenty-foixr  hours.  Urea 
and  ferment  produced  attacks  in  twenty  to 
forty  minutes ;  simple  ferment  gave  no  result. 
Ammonia  was  never  found  in  the  blood  or 
expired  air  during  the  attack,  but  often,  in  the 
former,  after  death.  He  frequently  obtained  no 
conclusive  results  from  his  experiments. — 
Robert  Saundby,  M.D. — London  Med.  Record. 


THE  NERVE-ELEMENT  IN  WHOOPING- 
COUGH. 

Of  late  years  the  profession  has  bestowed 
very  little,  if  any,  serious  scientific  attention 
on  some  of  the  commonest  of  common  maladies. 
Whooping-cough  is  conspicuously  among  the 
neglected  ills  to  which,  notwithstanding  the 
forgetfulness  of  the  multitude  of  earnest  clinical 
investigators,  flesh  is  still  heir.  Many  years 
ago  the  nerve-element  in  this  troublesome  and 
too  often  evil- working,  if  not  in  itself  dangerous, 
affection,  engaged  much  consideration,  and 
treatment  was  specially  directed  to  its  relief- 
It  would  be  well  if  the  investigation  of  this 
feature  of  the  etiology  of  the  affection  could 
be  resumed.  The  fact  that  pertussis  belongs  to 
the  class  ot  maladies  which  are  communicable 
and  "  catching "  does  not  take  it  out  of  the 
range  of  probability  that  the  specific  action  of 
a  morbific  poison  on  the  nerve  centres  may  be 
the  efficient  cause  of  the  disease.  Although 
the  occurrence  of  the  affection  happening  rarely 
more  than  once  in  the  life  of  any  individual 
may  seem  to  point  more  directly  to  the  fertilising 
of  latent  germs  in  the  organism  than  to  any 
special  excitation  of  the  nerve  centres,  we  do 
not,  as  yet,  know  enough  of  the  modus  operandi 
of  morbific  influences — **  germs,"  or  poisons  as 
we  call  them — in  the  blood  and  the  tissues  to 


define  the  part  which  the  nerve  centres  play  in 
the  production  of  morbid  phenomena.  In  any 
case,  such  relief  is  frequently  obtained  even  in 
the  earliest  stages  of  whooping-cough  from 
mild  periodic  counter-irritation  over  the  whole 
length  of  the  spinal  column  by  a  mustard- 
poultice,  which  merely  reddens  the  skin  with- 
out vesication,  that  it  would  be  well  worth 
while  to  study  this  method  closely  from  the 
therapeutic  as  well  as  the  clinical  standpoint. 
It  certainlv  does  good ;  but  how  1  In  cases 
where  the  mustard-poultice,  applied  for  six  or 
eight  minutes — not  longer — over  the  whole 
length  of  the  spine  immediately  before  putting 
the  child  to  bed  every  night,  for  a  week,  or,  in 
seriously  spasmodic  cases,  a  fortnight,  does  not 
procure  a  permanent  amelioration  of  the  cough, 
the  effect  of  this  remedy  is  enhanced  by  spong- 
ing the  spine  with  iced  water  quickly  each 
successive  morning.  In  cases  where  the  par- 
oxysms of  cough  seem  to  be  rej^eated  and  to 
continue  from  sheer  exhaustion  of  the  nerve 
centres,  coffee,  administered  as  a  drink,  will 
often  stimulate  the  energy  of  the  centres  so  as 
to  put  an  end  to  the  malady.  These  are  prac- 
tical points  which  require  theoretical  explana- 
tion.— London  Lancet. 


PNEUMONIA,  DIPHTHERITIC  GAS- 
TRITIS. 

Stated  Meeting,  January  6,  1882. 

Dr.  Osier  exhibited  (Montreal  Medico- 
Chirurgieal)  the  specimens,  which  were  taken 
from  a  man  aged  sixty-six,  who  was  admitted 
to  the  General  Hospital  with  great  shortness 
of  breath  and  prostration,  and  died  in  six  hours. 

Dr.  Bristowe,  of  St.  Thomas'  Hospital,  was 
the  first  to  describe  diphtheritic  inflammation  of 
the  alimentary  canal  in  pneumonia;  he  met  with 
it  in  the  colon  in  two  out  of  thirty  secondary, 
and  in  four  out  of  sixteen  primary  pneumonias. 
Dr.  Osier,  in  about  fifty  autopsies  in  primary 
pneumonia,  had  met  with  five  instances  of 
croupous  or  diphtheritic  colitis.  This  was  the 
first  specimen  in  which  the  stomach  was 
affected.  In  connection  with  this,  he  called 
attention  to  the  frequency  of  the  so-called 
diphtheritic  endocarditis  in  pneumonia  ;  thirty- 
eight  per  cent,   of  the  cases   which   he    had 


84 


CANADIAN  JOURNAL 


analysed  occurred  with  iitflamniatiun  of  the 
luQgs.  The  extreme  distention  of  tho  stomach 
had  probably  taken .  place  during  life  and  in 
connection  with  the  gastritis ;  it  doubtless 
assisted  in  bringing  about  the  fatal  termination 
by  embarrassing  the  heart  and  compressing  the 
healthy  lung. 

The  President,  Dr.  Ross,  remarked  on  the 
latency  of  pneumonia  in  old  men,  and  on  the 
special  liability  of  these  cases  to  sudden  death 
from  heart  failure. — Medical  News. 


Proper  Way  to  give  Aconite.  —  In  the 
London  Medical  Record,  Dr.  William  Murrell 
makes  some  judicious  observations  on  the  correct 
plan  for  administering  aconite  so  as  to  secure 
its  most  advantageous  action.  He  observes 
that  aconite  does  act  best  in  small  doses 
frequently  repeated.  Many  practitioners  get 
no  good  from  aconite  because  they  do  not  know 
how  to  use  it.  The  dose  of  the  tincture  recom- 
mended in  the  British  Pharmacopoeia — from 
five  to  fifteen  minims — is  absurdly  large,  and 
no  one  with  any  respect  for  his  patient's  safety, 
or  his  own  reputation,  would  think  of  giving 
it.  The  best  way  is  to  put  half  a  drachii.  of 
the  tincture  in  a  tour-ounce  bottle  of  water, 
and  to  tell  the  patient  to  take  a  teaspoonful  of 
this  every  ten  minutes  for  the  first  hour,  and 
after  this  hourly  for  some  hours.  Even  smaller 
doses  may  be  given  in  the  case  of  children. 
The  great  indication  for  the  use  of  aconite  is 
elevation  of  temperature ;  the  clinical  thermo- 
meter and  aconite  bottle  should  go  hand  in 
hand.  If  properly  used,  aconite  is  one  of  the 
most  valuable  and  indispensable  drugs  in  the 
Pharmacopoeia. — Kansas  Medical  Index. 


Hammond  on  the  Therapeutical  Uses  of 
Nitro-Glycerine, — At  a  meeting  of  the  New 
rork  Neurol.  Soc,  held  on  Oct.  4, 1881,  Dr.  W. 
A.  Hammond  read  a  paper  on  the  therapeutics 
of  nitro-glycerine.  Ho  had  used  it  with  much 
success  in  the  treatment  of  migraine.  A  very 
severe  caso  was  described.  Previous  remedies 
had  done  no  good.  One  drop  of  the  one  per 
cent,  solution  was  given ;  pain  almost  instantly 
ceased,  and  in  fifteen  minutes  the  patient  was 
up  and  well.  Five  days  later  she  had  a  similar 
attack,  which  was  cured  as  before.     She  was 


then  put  on  a  regular  course  of  the  drug,  and 
for  the  last  nine  months  has  not  had  a  single 
attack.  In  was  given  in  from  fifteen  to  twenty 
cases,  with  the  most  complete  success.  He  was 
satisfied  that  it^was  of  use  in  epilepsy,  and 
often  gave  it  in  the  status  epilepticus  when  the 
bromides  and  other  remedies  had  failed.  A 
child  who  had  sufibred  from  epilejjtic  attacks 
three  or  four  times  a  week  for  two  years,  was 
cured  by  drop-doses  of  the  one  per  cent,  solu- 
tion. He  had  also  used  it  with  benefit  in 
angina  pectoris.  —  Wm.  Murrell,  M.D. — 
London  Med.  Record. 


On  the  Diagnostic  Value  of  Alveolar 
Periostitis  of  the  Jaws  in  Saccharine  Dia- 
betes.— M.  Magitot  read  under  this  title  a  me- 
moir of  which  the  following  are  the  conclusions: 
(1)  A  roughness  of  the  alveolar  border  known 
as  alveolar  osteo-periostitis  is  a  constant  sign 
of  saccharine  diabetes.  (2)  This  manifestation 
of  diabetes  which  occurs  at  the  beginning  of 
the  disease,  and  which  persists  throughout  its 
course,  acquires  in  certain  cases  a  pathog- 
nomonic importance.  (3)  In  the  first  stage  of 
diabetes  the  alveolar  lesion  is  characterized  by 
deviation  of  the  teeth.  In  the  second  stage 
there  is  loosening  of  the  teeth  and  alveolar 
catarrh.  In  a  more  advanced  stage  there  is 
falling  out  of  the  teeth,  and  finally  there  is 
absorption  of  bone  consecutive  or  not  to  partial 
gangrene  of  the  gum.  This  last  sign  is  critical, 
and  but  shortly   precedes  death. — Gazette  dea 

Hopitaux. 

■  ■#» « 

Cure  of  Goitre  by  Fluoric  Acid.  —  Dr. 
Edward  Woakes  gives,  in  the  Lancet,  a  de 
tailed  account  of  a  number  of  cases  of  goitre 
cured  by  fluoric  acid  internally.  He  begins 
treatment  with  fifteen  minims  of  a  one-half  per 
cent,  dilution  of  the  acid  three  times  a  day, 
and,  if  necessary,  increases  the  dose  to  twenty, 
thirty,  forty,  or  even  seventy  minims,  and 
extends  the  time  to  several  months.  His  re- 
sults are  quite  remarkable,  even  in  cases  that 
had  resisted  iodine,  bromine,  iron,  etc.  In  a 
few  it  was  conjoined  with  injections  of  tinct. 
iodine.  Very  few  failed  to  be  reasonably 
benefitted,  and  in  eighty-five  per  cent,  the  cure 
was  decided. — Louiv.  Med.  News. 


OF  MEDICAL  SCIENCE. 


80 


Tests  of  Insanity. — The  clinical  investiga- 
tion of  mental  disease  is  jnst  as  precise  and 
elaborate  a  process  as  the  clinical  examination 
of  a  case  of  physical  disease.  The  scientific 
medical  psychologist  does  not  ask  a  few  capri- 
cious questions,  and  either  guess  the  state  of 
the  cerebrum  or  arrive  at  the  truth  by  some 
intuitive  genius.  If  he  is  what  he  professes  to 
be,  he  tests  each  function  of  the  brain  sepai*- 
ately,  trying  it  by  definitive  tests  and  stan- 
dards, and  thus  ascertains  the  condition  of  the 
organ  as  a  whole.  If  science  has  not  placed 
the  brain  on  a  footing  with  the  liver  and  the 
kidneys  as  regards  the  study  of  its  functions, 
it  has  done  nothing.  It  is  important  that  this 
should  be  clearly  recognized.  In  a  word, 
psychology  is  psychology,  so  far  as  the  physi- 
cian is  concerned  ;  and  no  man  can  be  anything 
else  than  a  charlatan  in  mental  practice  unless 
he  is  a  physiologist. — Lancet. 


Mile  Diet  in  Bright's  Disease. — During 
the  last  few  years  milk  diet  has  been  recom- 
mended by  many  in  the  treatment  of  Bright's 
disease,  and  yet  we  fear  sufl&cient  importance 
is  not  attached  to  it  by  the  profession.  The 
Philadelphia  Medical  and  Surgical  Reporter 
says,  "That  Dr.  Wra.  Mitchell  of  that  city, 
who  employs  it  largely,  is  quite  an  enthusiast 
on  the  subject.  He  uses  thoroughly  skimmed 
milk  and  confines  his  patients  strictly  to  this 
food,  i.e.,  allows  them  nothing  but  the  milk, 
and  continues  such  treatment  for  a  long  time. 
When  the  milk  disagrees  with  the  stomach,  he 
puts  the  patient  in  bed,  and  commences  with 
small  doses,  one  tablespoonful  with  some  lime- 
water,  and  gradually  increases  until  he  is  able 
to  take  eight  or  ten  pints  of  milk  during  the 
day,  and  absolutely  nothing  else. 


Administration  op  Turpentine. — Turpen- 
tine, which  is  often  of  value  in  typhoid  and 
other  adynamic  fevers,  is  a  very  difficult  remedy 
to  administer.  Stokes  (Lectures  on  Fever)  used 
to  administer  it  in  combination  with  egg-nogg. 
The  Courrier  Medical  proposes  the  following 
formula  which,  it  claims,  destroys  the  taste  and 
odor  :  Essence  of  turpentine,  two  drachms  ; 
sulphuric  ether,  forty-five  minims  ;  these  should 
be  thoroughly  mixed,  after  which  an  ounce  of 


orange  flower  syrup  and  four  ounces  of  water 
are  to  be  added.  Of  this  mixture  a  dessert- 
spoonful should  be  given  every  two  hours,  or 
according  to  the  indications. — Chicago  Medical 
Review. 


At  the  Medical  Society  of  the  Hospitala 
M.  Kilner  read  a  report  of  the  case  of 
a  man  34  years  of  age,  who,  after  taking  60 
grammes  of  pomegranate  root,  followed  in  two 
hours  by  a  dose  of  castor  oil,  passed  720 
grammes  of  taenia.  The  fragments  placed  end 
to  end  measured  70  metres,  and  there  were 
27  heads  of  taenia  unarmed  counted.  M. 
Ki6ner  recommends  the  dose  of  oil  to  be  given 
not  longer  than  two  or  two  and  a-half  hours 
after  the  pomegranate  root  as  the  taenifuges  do 
not  kill  the  worm,  only  stupefy  it,  and  they 
hold  loosely  to  the  mucous  membrane. — 
L' Union  MiJical. 


Simple  Continued  Fever. — R.  Acid.  Hydro- 
brom.,  5i;  Syr.  Simplic,  5iij  Aq.  ad.  ji.  M. 
Sig.  Every  hour. — Fothergill.  Dr.  Fothergill, 
in  speaking  of  the  abave  formula,  says  it  will 
probably  constitute,  par  excellence,  the  fever 
mixture  of  the  future.  It  is  especially  indi- 
cated where  there  is  cerebral  disturbance. — If. 
Y.  Med.  Record. 


Trophic  Nerves  and  Nerve  Centres. — 
Brain,  says  Jariscb,  of  Vienna,  has  made  the 
interesting  observation  that  the  anterior  cornua 
of  the  cord  were  variously  diseased  in  several 
cases  of  skin  disease,  viz.  :  Herpes  iris,  long- 
standing psoriasis,  and  acute  lupus  erythema- 
tosus.— Centrlft.  f.  d.  Med.  Wiss. 


New  Method  of  Preparing  the  Spinal 
Cord  for  Microscopic  Sections. — Debove 
recommends  in  the  Archives  de  Neurologie  the 
following  method  : — Place  the  cord  in  a  4  per 
cent,  solution  of  bichromate  of  ammonia  for 
three  weeks,  then  in  a  solution  of  phenic  gum 
for  three  days,  and  for  three  days  more  in 
alcohol.  Sections  may  then  be  cut  with  gi-eat 
facility.  They  should  be  placed  in  water  to 
prevent  curling.  They  ai'e  then  immersed  in 
a  saturated  solution  of  picric  acid  for  twenty- 
four  hours,  and  coloured  with  carmine  for 
about  twenty  minutes,  the  picric  acid  acting 
as  a  mordant. — British  Medical  JoumaL 


84 


CANADIAN  JOURNAL 


analysed  occdned  witli  inflamniation  of  the 
lungs.  The  extreme  distention  of  ili.-;  Mumacii 
had  probably  taken,  place  during  life  and  in 
connection  with  the  gastritis ;  it  doubtless 
assisted  in  bringing  about  the  fatal  termination 
by  embarrassing  the  heart  and  cora[)ressing  the 
healthy  lung. 

The  President,  Dr.  Ross,  remarked  on  the 
latency  of  pneumonia  in  old  men,  and  on  the 
special  liability  of  these  cases  to  sudden  death 
from  heart  failure. — Medical  News. 


Proper  Way  to  give  Aconite.  —  In  the 
London  Medical  Record,  Dr.  William  Murrell 
makes  some  judicious  observations  on  the  correct 
plan  for  administering  aconite  so  as  to  secure 
its  most  advantageous  action.  He  observes 
that  aconite  does  act  best  in  small  doses 
frequently  repeated.  Many  practitioners  get 
no  good  from  aconite  because  they  do  not  know 
how  to  use  it.  The  dose  of  the  tincture  recom- 
mended in  the  British  Pharmacopceia — from 
five  to  fifteen  minims — is  absurdly  large,  and 
no  one  with  any  respect  for  his  patient's  safety, 
or  his  own  reputation,  would  think  of  giving 
it.  The  best  way  is  to  put  half  a  drachii.  of 
the  tincture  in  a  tour-ounce  bottle  of  water, 
and  to  tell  the  patient  to  take  a  teaspoonful  of 
this  every  ten  minutes  for  the  first  hour,  and 
after  this  hourly  for  some  hours.  Even  smaller 
doses  may  be  given  in  the  case  of  children. 
The  great  indication  for  the  use  of  aconite  is 
elevation  of  temperature ;  the  clinical  thermo- 
meter and  aconite  bottle  should  go  hand  in 
hand.  If  properly  used,  aconite  is  one  of  the 
most  valuable  and  indispensable  drugs  in  the 
Pharmacopoeia. — Kansas  Medical  Index. 


Hammond  on  the  Therapeutical  Uses  of 
Nitro-Glycerine. — At  a  meeting  of  the  New 
York  Neurol.  Soc,  held  on  Oct.  4, 1881,  Dr.  W. 
A.  Hammond  read  a  paper  on  the  therapeutics 
of  nitro-glycerine.  He  had  used  it  with  much 
success  in  the  treatment  of  migraine.  A  very 
severe  case  was  described.  Previous  remedies 
had  done  no  good.  One  drop  of  the  one  per 
cent,  solution  was  given  ;  pain  almost  instantly 
ceased,  and  in  fifteen  minutes  the  patient  was 
up  and  well.  Five  days  later  she  had  a  similar 
attack,  which  was  cured  as  before.     She  was 


tlien  put  on  a  regular  course  of  the  drug,  and 
for  the  last  nine  months  has  not  had  a  single 
attack.  In  was  given  in  from  fifteen  to  twenty 
cases,  with  the  most  complete  success.  He  was 
satisfied  that  it^was  of  use  in  epilepsy,  and 
often  gave  it  in  the  status  epilepticus  when  the 
bromides  and  other  remedies  had  failed.  A 
child  who  had  suffered  from  epileptic  attacks 
three  or  four  times  a  week  for  two  years,  was 
cured  by  drop-doses  of  the  one  per  cent,  solu- 
tion. He  had  also  used  it  with  benefit  in 
angina  pectoris.  —  Wm.  Murrell,  M.D. — 
London  Med.  Record. 


On  the  Diagnostic  Value  of  Alveolar 
Periostitis  op  the  Jaws  in  Saccharine  Dia- 
betes.— M.  Magitot  read  under  this  title  a  me- 
moir of  which  the  following  are  the  conclusions : 
(1)  A  roughness  of  the  alveolar  border  known 
as  alveolar  osteo-periostitis  is  a  constant  sign 
of  saccharine  diabetes.  (2)  This  manifestation 
of  diabetes  which  occurs  at  the  beginning  of 
the  disease,  and  which  persists  throughout  its 
course,  acquires  in  certain  cases  a  pathog- 
nomonic importance.  (3)  In  the  first  stage  of 
diabetes  the  alveolar  lesion  is  characterized  by 
deviation  of  the  teeth.  In  the  second  stage 
there  is  loosening  of  the  teeth  and  alveolar 
catarrh.  In  a  more  advanced  stage  there  is 
falling  out  of  the  teeth,  and  finally  there  is 
absorption  of  bone  consecutive  or  not  to  partial 
gangrene  of  the  gum.  This  last  sign  is  critical, 
and  but  shortly  precedes  death. — Gazette  des 
Hopilaux. 

. »  m^m  m 

Cure  of  Goitre  by  Fluoric  Acid.  —  Dr. 
Edward  Woakes  gives,  in  the  Lancet,  a  de 
tailed  account  of  a  number  of  cases  of  goitre 
cured  by  fluoric  acid  internally.  He  begins 
treatment  with  fifteen  minims  of  a  one-half  per 
cent,  dilution  of  the  acid  three  times  a  day, 
and,  if  necessary,  increases  the  dose  to  twenty, 
thirty,  forty,  or  even  seventy  minims,  and 
extends  the  time  to  several  months.  His  re- 
sidts  are  quite  remarkable,  even  in  cases  that 
had  resisted  iodine,  bromine,  iron,  etc.  In  a 
few  it  was  conjoined  with  injections  of  tinct. 
iodine.  Very  few  failed  to  be  reasonably 
benefitted,  and  in  eighty-five  per  cent,  the  cure 
was  decided. — Louiv.  Med.  News. 


OF  MEDICAL  SCIENCE. 


86 


Tests  op  Insanity. — The  clinical  investiga- 
tion of  mental  disease  is  just  as  precise  and 
elaborate  a  process  as  the  clinical  examination 
of  a  case  of  physical  disease.  The  scientific 
medical  psychologist  does  not  ask  a  few  capri- 
cious questions,  and  either  guess  the  state  of 
the  cerebrum  or  arrive  at  the  truth  by  some 
intuitive  genius.  If  he  is  what  he  professes  to 
be,  he  testa  each  function  of  the  brain  separ- 
ately, trying  it  by  definitive  tests  and  stan- 
dards, and  thus  ascertains  the  condition  of  the 
organ  as  a  whole.  If  science  has  not  placed 
the  brain  on  a  footing  with  the  liver  and  the 
kidneys  as  regards  the  study  of  its  functions, 
it  has  done  nothing.  It  is  important  that  this 
should  be  clearly  recognized.  In  a  word, 
psychology  is  psychology,  so  far  as  the  physi- 
cian is  concerned  ;  and  no  man  can  be  anything 
else  than  a  charlatan  in  mental  practice  unless 
he  is  a  physiologist. — Lancet. 


Milk  Diet  in  Bright's  Disease. — During 
the  last  few  years  milk  diet  has  been  recom- 
mended by  many  in  the  treatment  of  Bright's 
disease,  and  yet  we  fear  suflScient  importance 
is  not  attached  to  it  by  the  profession.  The 
Philadelphia  Medical  and  Surgical  Reporter 
says,  "  That  Dr.  Wni.  Mitchell  of  that  city, 
who  employs  it  largely,  is  quite  an  enthusiast 
on  the  subject.  He  usea  thoroughly  skimmed 
milk  and  confines  his  patients  strictly  to  this 
food,  i.e.,  allows  them  nothing  but  the  milk, 
and  continues  such  treatment  for  a  long  time. 
When  the  milk  disagrees  with  the  stomach,  he 
puts  the  patient  in  bed,  and  commences  with 
small  doses,  one  tablespoonful  with  some  lime- 
water,  and  gradually  increases  until  he  is  able 
to  take  eight  or  ten  pints  of  milk  during  the 
day,  and  absolutely  nothing  else. 

«  ^» w  » 

Administration  op  Turpentine. — Turpen- 
tine, which  is  often  of  value  in  typhoid  and 
other  adynamic  fevers,  is  a  very  diflScult  remedy 
to  administer.  Stokes  (Lectures  on  Fever)  used 
to  administer  it  in  combination  with  egg-nogg. 
The  Courrier  Medical  proposes  the  following 
formula  which,  it  claims,  destroys  the  taste  and 
odor  :  Essence  of  turpentine,  two  drachms ; 
sulphuric  ether,  forty-five  minims  ;  these  should 
be  thoroughly  mixed,  after  which  an  ounce  of 


orange  flower  syrup  and  four  ounces  of  water 
are  to  be  added.  Of  this  mixture  a  dessert- 
spoonful should  be  given  every  two  hours,  or 
according  to  the  indications. — Chicago  Medical 
Review. 


At  the  Medical  Society  of  the  Hospitals 
M.  Ki^ner  read  a  report  of  the  case  of 
a  man  34  years  of  age,  who,  after  taking  60 
grammes  of  pomegranate  root,  followed  in  two 
hours  by  a  dose  of  castor  oil,  passed  720 
grammes  of  taenia.  The  fragments  placed  end 
to  end  measured  70  metres,  and  there  were 
27  heads  of  taenia  unarmed  counted.  M. 
Ki^ner  recommends  the  dose  of  oil  to  be  given 
not  longer  than  two  or  two  and  a-half  hours 
after  the  pomegranate  root  as  the  tsenifuges  do 
not  kill  the  worm,  only  stupefy  it,  and  they 
hold  loosely  to  the  mucous  membrane. — 
L' Union  Medical. 


Simple  Continued  Fever. — R.  Acid,  Hydro- 
brom.,  5i;  Syr.  Simplic,  5ii;  Aq.  ad.  Ji.  M, 
Sig.  Every  hour. — Fothergill.  Dr.  Fothergill, 
in  speaking  of  the  ab3ve  formula,  says  it  will 
probably  constitute,  par  excellence,  the  fever 
mixture  of  the  future.  It  is  especially  indi- 
cated where  there  is  cerebral  disturbance. — y. 
Y.  Med.  Record. 


Trophic  Nerves  and  Nerve  Centres. — 
Brain,  says  Jariscb,  of  Vienna,  has  made  the 
interesting  observation  that  the  anterior  cornua 
of  the  cord  were  variously  diseased  in  several 
cases  of  skin  disease,  viz.  :  Herpes  iris,  long- 
standing psoriasis,  and  acute  lupus  erythema- 
tosus.— Gentrlft.f.  d.  Med.  Wiss. 


New  Method  of  Preparing  the  Spinal 
Cord  for  Microscopic  Sections. — Debove 
recommends  in  the  Archives  de  Neurologie  the 
following  method  : — Place  the  cord  in  a  4  per 
cent,  solution  of  bichromate  of  ammonia  for 
three  weeks,  then  in  a  solution  of  phenic  gum 
for  three  days,  and  for  three  days  more  in 
alcohol.  Sections  may  then  be  cut  with  great 
facility.  They  should  be  placed  in  water  to 
prevent  curling.  They  are  then  immersed  in 
a  saturated  solution  of  picric  acid  for  twenty- 
four  hours,  and  coloured  with  carmine  for 
about  twenty  minutes,  the  picric  acid  acting 
as  a  mordant. — British  Medical  Journal. 


88 


CANADIAN  JOURNAL 


dressed  with  iodoform.  The  result  was  excel- 
lent. MM.  Tr61at  and  Vei'neuil  had  spoken  of 
the  good  effects  on  exposed  wounds,  he  wished, 
on  the  contrary,  to  call  attention  to  the  ser- 
vices rendered  by  it  in  deep,  irregular  wounds, 
difficult  to  cleanse.  There  wounds  are,  to  my 
mind,  a  veritable  triumph  for  iodoform,  which 
has  been  claimed  as  a  true  specific  for  tubercle. 
There  have  been  obtained  cures  of  fu'igous 
while  swellings,  by  injections  of  iodoform,  dis" 
solved  in  ether.  Iodoform  does  not  act,  as  M. 
Despr6<  believes,  like  tincture  of  iodine,  which 
only  acts  during  some  minutes,  whilst  the 
action  of  iodoform  is  maintained  for  more  than 
eight  days. — Gazette  des  Hojntaux. 


SUPPURATING  CYST  OF  LIVER  CURED 
BY  A  SINGLE  PUNCTURE. 

At  the  Clinical  Society  of  Paris,  in 
December,  M.  Rendu  reported  a  case  of  this 
kind.  M.  Quinquand  laid  stress  upon  the 
fact  that  the  temperature  in  M.  Rendu's 
case  was  normal  before  and  after  the  puncture. 
Now  it  is  a  clinical  fact,  of  which  he  has  been 
convinced  by  several  examples,  apyretic  puru- 
lent collections,  whether  they  occur  in  the 
pleura  or  in  the  liver,  are  often  cured  by  one 
or  two  punctures.  Apropos  of  this  M.  Quin- 
quand cited  an  interesting  case  which  he  had 
observed  in  the  Hopital  Saint  Antoine.  A 
patient  had  been  under  treatment  for  a  year 
for  cancer  of  the  stomach  characterized  by  a 
tumour  bulging  in  the  epigastric  region,  and  by 
various  mechanical  disturbances,  notably  un- 
controllable vomitings.  The  clinical  characters 
of  cancer,  however,  were  wanting  :  in  the  first 
place,  the  tumour  appeai'ed  to  occupy  the  in- 
ferior surface  of  the  liver,  and  the  hematic  lesions 
observed  were  not  those  of  cancer  ;  in  fact  the 
patient  presented  10  to  12,000  white  globules  per 
cubic  metre  of  blood,  a  proportion  usual  in  the 
leucocytosis  of  suppuration.  Relying  upon 
these  features  M.  Quinquaud  made  the  diagnosis 
of  encysted  purulent  perihepatic  peritonitis  j 
and  in  fact  tapping  in  the  prominent  region 
gave  issue  to  1,500  or  1,600  grammes  of  pus. 
There  were  no  consecutive  accidents.  The  very 
next  day  an  exceedingly  good  appetite  replaced 
the   anorexia  and  the   vomiting    which    had 


brought  the  patient  to  a  marasmic  state,  and  in 
eight  days  there  was  observed  an  increment  of 
body  weight  of  '6\  kilogrammes.  After  the 
tapping  no  deformity  of  the  liver  was  made  out, 
whence  the  conclusion  that  the  purulent  collec- 
tion was  indeed  extra-hepatic. 

M.  Rendu  admitted  the  comparative  fre- 
quency of  cure  of  extra-hepatic  purulent  collec- 
tions after  a  single  puncture,  but  he  was  not 
aware  of  any  case  of  similar  cure  of  intra-hepatic 
abscess.  It  was  in  this  particular  that  the 
interest  of  his  case  lay. 

M.  Delens  instanced  two  cases  which  con- 
firm the  therapeutic  conclusions  of  M.  Rendu. 
In  a  man  affected  with  an  inflammatory  swell- 
of  the  hepatic  region  regarded  by  MM.  Delens 
and  Duguet  as  being  a  suppurating  hydatid 
cyst  of  the  liver,  a  single  puncture  made  with 
Potain's  aspirator  was  followed  by  cure.  More 
recently  M.  Delens  l\^d  practised  two  succes- 
fcive  tappings  of  the  liver  in  the  ease  of  a  lady 
affected  with  an  hydatid  cyst ;  the  first  time 
there  was  an  evacuation  of  two  litres  of  a  fluid 
as  clear  as  water  from  the  rock ;  the  second 
puncture  gave  issue  to  a  purulent  fluid.  Since 
the  second  operation,  done  fifteen  months  ago, 
the  fluid  has  not  been  reproduced.  M.  Rendu 
concludes  from  these  cases,  and  from  his  own, 
that  facts  of  this  kind  have  been  already 
observed,  but,  so  far  as  he  is  aware,  have  not 
been  recorded  in  medical  literature. 


Treatment  op  Bullet- Wounds.  —  In  a 
report  made  to  the  Society  de  Chirurgie 
relative  to  fractures  by  pistol  balls,  M.  Ver- 
neuil  declares  that  for  ten  years  he  has  always 
abstained  from  intervention  in  wounds  and 
fractures  produced  by  firearms,  and  he  has 
always  been  fortunate  in  this  abstention.  He 
is  altogether  of  the  opinion  of  those  who 
think  that  the  part  in  which  the  wound  or 
fracture  is  situated  should  be  immobilised  as 
far  as  possible,  and  no  attempt  made  to 
find  the  missile.  In  regions  where  this  im- 
mobilisation cannot  be  effected  in  a  perfect 
manner,  as  in  the  chest  or  abdomen  he  applies 
upon  the  wound  a  bit  of  collod ionised  gauze, 
and  surrounds  the  region  with  a  bandage 
agreeably  tightened.  MM.  LeDentu,  Nicaise, 
Despr^s,  Anger,  Terrier,  and  Chauvel,  expressed 
similar  views. — U Union  Medical. 


OF  MEDICAL  SCIENCE. 


8» 


Vincent  on  the  Treatment  of  Wounds  of 
THE  Bladder  — In  an  original  memoir  (Kevue 
de  Chir.,  Nos.  6.  and  7,  1881)  on  penetrating 
intraperitoneal  wounds  of  the  bladder,  Professor 
E,  Vincent,  of  Lyons,  states  that  the  operation 
of  laparotomy  is  the  only  suitable  treatment 
for  such  injuries  when  followed  by  an  abundant 
effusion  of  urine  into  the  peritoneal  cavity. 
This  treatment  alone  permits — 1.  Direct  in- 
spection of  the  seat  of  injury ;  2.  The  determin- 
ing of  the  presence  and  of  the  nature,  if  they 
are  present,  of  complications;  3.  Removal  from 
the  abdomen  of  effused  blood  and  uriny ;  4. 
Cleansing  and  disinfection  of  the  peritoneal 
cavity  ;  and,  finally,  the  prevention  of  further 
effusion  of  urine  by  applying  sutures  to  the 
wound  through  the  coats  of  the  bladder.  This 
plan  of  treatment  is  rendered  justifiable  by  as- 
sociation with  the  antiseptic  method,  and  also 
by  the  success  of  laparotomy  in  abdominal 
surgery.  Moreover,  in  cases  of  penetrating 
wound  of  the  bladder,  death  is  an  almost  cer- 
tain result  if  nothing  be  done,  and  even  if  any 
treatment  short  of  laparotomy  be  applied. 
From  an  analysis  of  three  reported  cases  in 
which  wound  of  the  bladder  has  been  thus 
treated  (Walter  of  Pittsburg,  Heath,  Willett), 
and  also  from  the  results  of  numerous  experi- 
ments on  dogs.  Dr.  Vincent  has  drawn  the 
conclusions  that  it  is  of  great  importance  in 
instances  of  this  injury  to  have  recourse  to 
laparotomy  as  early  as  possible,  and  that  in 
this  plan  of  treatment  particular  care  must  be 
taken  in  applying  the  sutures  to  the  vesical 
wound.  His  experimental  researches  have 
demonstrated,  it  i?  stated,  that  intraperitoneal 
wounds  of  the  bladder  are  capable  of  healing 
by  primary  intention  if  securely  closed  by 
Buture,  and  that  this  union  is  accomplished 
very  rapidly  by  all  the  coats  of  the  bladder, 
except  by  the  epithelial  layer  of  the  mucous 
coat.  The  outer  layer  of  this  coat  and  the  mus- 
cular coat  join  together  very  quickly,  yet  with 
less  readiness  than  the  peritoneal  coat,  the 
proliferation  of  which  commences  almost  im- 
mediately after  coaptation.  The  sutures  are 
applied  very  closely  together,  and  in  a  double 
set.  In  one  set — the  sero-muscular — each 
suture  is  passed  through  the  peritoneal  and 
muscular  coats  of  the  bladder  on  each  side  of 


the  wound  ;  in  the  other  set — the  sero-serous — 
the  peritoneum  only  is  traversed,  a  considerable 
width  of  this  coat  being  included  on  both  sides, 
so  that  when  these  sutures  are  tied  wide  serous 
surfaces  are  brought  together  in  close  contact. 
The  mucous  membrane  of  the  wounded  bladder 
is  not  included  in  any  of  the  sutures.  Dr. 
Vincent  concludes  from  his  experiments  on 
dogs  that  by  this  plan  the  wound  may  be 
securely  closed,  and  that  sutures  thus  applied 
will  resist  vesical  tenesmus,  and  any  effort  of 
active  contraction  or  of  passive  expansion  that 
may  subsequently  be  made  by  the  bladder- 
There  need  not,  he  states,  be  any  fear  of  subse- 
quent perforation  of  vesical  wall,  through  for- 
mation of  fistulse  along  the  track  of  the  sutures 
or  in  the  intervals,  or  of  any  ulterior  deposition 
of  lithates  around  sutures  shed  into  the  cavity 
of  the  bladder.  The  sutures,  being  intra- 
parietal,  remain  at  or  near  the  outer  surface  of 
the  organ.  In  cystorrhaphy  the  author  prefera 
a  suture  of  silver  wire  or  of  silk  to  one  of  cat- 
gut. The  last  material  breaks  too  readily, 
and  is  likely  to  melt  away  too  quickly.  Be- 
fore closing  the  abdominal  wound,  it  is 
thought  necessary  to  test  the  security  of  the 
vesical  suturing  by  injecting  some  coloured  and 
indifferent  fluid  into  the  bladder.  From  a 
series  of  experiments  on  dogs.  Dr.  Vincent  has 
made  out  that  gun-shot  wounds,  also  of  the 
bladder,  heal  by  immediate  union  after  applica- 
tion of  sutures  according  to  the  above  de- 
scribed method,  unless  the  deflagration  of  the 
powder,  or  the  heat  of  the  pi'ojectile,  have  de 
stroyed  the  vitality  of  the  tissues  at  the  edge  of 
the  wound,  and  rendered  local  gangrene  inevit- 
able. In  such  cases,  the  burnt  lips  of  the  per- 
foration should  be  removed,  and  adjacent 
portions  of  the  vesical  walls  also  excised, 
until  the  tissues  are  seen  to  bleed  on  section. 
Dr.  Vincent  states  that,  in  his  experiments  on 
dogs,  he  has  now  proved  that,  as  a  rule,  im- 
mediate union  results  from  the  immediate 
application  of  sutm-es  in  intra-peritoneal  wounds 
of  the  bladder  by  laceration,  and  through  the 
action  of  cutting  instruments  and  fire-arms.  In 
such  cases,  laparotomy,  with  suturing  of  the 
bladder  and  removal  of  blood  and  urine  from 
the  abdominal  cavity,  is  likely  to  prove  suc- 
cessful on  the  dog,    when  performed  in  eight 


90 


CANADIAN  JOURNAL 


hours  and  a  half  after  the  receipt  of  injury;  but 
in  Dr.  Vincent's  hands,  always  failed  after  an 
interval  of  twenty-four  hours,  the  animals 
having  .succumbed  to  urinary  poisoning.  In 
conclusion,  Dr,  Vine  mt,  impressed  by  the  suc- 
cess of  his  experimental  investigations  on  early 
laparotomy  and  stitching  of  vesical  wound, 
argues  in  favour  of  suprapubic  over  perineal 
lithotomy,  and  asks  why  the  former  operation, 
which  affords  free  and  ready  access,  is  exempt 
from  the  danger  of  wounding  important  vessels, 
and  is  less  likely  to  result  in  phlebitis  and 
septic  poisoning,  is  not  more  frequently  prac- 
tised— London  Medical  Record. 


ACNE. 

INTERNAL   TREATMENT. 

If  constipation  exist,  saline  or  vegetable 
laxatives  should  be  prescribed  in  sufficient 
quantity  to  open  the  bowels  once  or  twice  a 
day.  An  occasional  dose  of  blue  pill  or  o*^ 
calomel  will  in  some  cases  prove  beneficial. 
Where  there  is  a  furred  tongue  and  disorder  of 
the  stomach  and  bowels  excellent  results  may 
be  obtained  from  the  tbllowing  : — 

R.  Magnesise  sulph.,  Jiss;  ferri  sulph.,  gr.  xvj  J 
acidi  sulphurici  dil.,  5ii;  aquse,  5viij,  M.  Sig. 
Tablespoonful  to  a  gobletful  of  water. 

LOCAL   TREATMENT. 

R.  Sulphur,  prsecipitati,  5  j  ;  glycerines,  5ss ; 
adipis  benz.,  Jj  j  o^-  I'osse,  gtt.  iij.  M.  Ft. 
ungt.  Sig. — To  be  thoroughly  rubbed  into 
the  skin  at  night. — DuHRlNO. 

Or,  Sulphuris'loti,  5  j  ;  aetheris,  S'^j  >  alco- 
holis,  5"J88-  M.  Sig.  Apply  as  a  lotion. 
Shake  the  bottle  before  using. —  Bulkley. — 
Quarterly  Epitome. 


Torticollis — Resection  of  Spinal  Acces- 
sory.— M.  Tillaux,  at  the  Academy  of  Medi- 
cine, mentioned  the  case  of  a  young  woman, 
thirty-two  years  of  age,  who  had  been  suffering 
for  some  months  with  the  following  phenomena : 
As  soon  as  the  head  was  left  to  itself  it  was 
carried  towards  the  right  shoulder,  the  chin 
deviating  to  the  left,  in  the  attitude  of  torti- 
collis. This  motion  was  accompanied  by  a 
^arp  pain  in  the  superior  vertebral  articula- 


tions. She  had  been  subjected  to  treatment  by 
electricity,  magnetism,  metallotherapy,  iodide 
of  potassium,  bromide  of  potassium,  and  divi- 
sion of  the  sterno-mastoid,  and  mechanical 
appliances,  without  benefit.  M.  Tillaux  then 
suspecting  that  the  spinal  accessory  nerve  was 
the  cause  of  these  troubles  determined  to  re- 
sect it.  Drawing  two  horizontal  lines,  one 
through  the  angle  of  the  jaw,  where  the  nerve 
leaves  the  parotid  gland,  and  the  other  through 
the  upper  border  of  the  thyroid  cartilage,  he 
made  an  incision  between  these  two  lines, 
dividing  the  skin,  subcutaneous  cellular  tissue, 
and  platysma.  Having  reached  the  sterno- 
mastoid,  he  raised  its  border,  and  laid  bare  the 
nerve.  Raising  this  with  a  hook  he  resected 
about  three  centimetres  of  its  length.  The 
wound  was  closed,  and  Lister's  dressing  ap- 
plied ;  the  i-esult  was  eminently  satisfactory, — 
the  patient  receiving  relief  that  she  had  not 
experienced  for  two  years  before. — L' Union 
Med. 


Improved  Dressing  for  Fractured  Clav- 
icle, by  Dr.  Lorenzo  Hale,  of  Albany.  The 
principle  of  the  plan  was  the  same  as  that  pre- 
sented to  the  Society  (N.  Y.  State  Medical)  in 
1870,  by  Dr.  E.  M.  Moore,  of  Kochester.  It 
differed  from  it  in  being  simply  a  suspender, 
"  back  sling,"  so  applied  as  to  bring  the  frag- 
ments into  apposition,  and  leave  the  clavicle 
exposed  to  view  : — 

Hold  one  end  of  a  narrow  roller  bandage 
against  the  scapula  of  one  side,  passing  it 
under  the  forearm  of  the  injured  side,  near  the 
elbow, — the  elbow  being  bent  and  drawn  far 
back, — thence  up  the  same  forearm,  across  the 
back  to  the  axilla  of  the  sound  side,  and  then 
in  front  of  and  over  the  sound  shoulder,  unit- 
ing the  ends  at  the  place  of  beginning. — Medi- 
cal News. 


Cystitis. — R.  Acidi  benzoici,  sodii  biboratis, 
aa.  gr.  x. ;  Inf.  buchu,  Jij.  This  amount  three 
or  four  times  a  day. — A.  J.  C.  Skene.  This 
may  almost  be  called  specific  in  its  influence  in 
the  earlier  stages  of  Cystitis,  affording  rapid 
and  lasting  relief.  The  diet  should  be  care- 
fully regulated,  and  the  skin  and  bowels  kept 
in  active  condition. — N.  7.  Meti.  Hecord, 


OF  MEDICAL  SCIENCE. 


9i 


Torsion  of  Arteries. — At  Guy's  Hospital 
all  the  surgeons  ase  torsion  to  the  exclusion 
of  the  ligature,  except  sometimes  in  very  small 
vessels  wherein  it  is  difficult  to  isolate  the  vessel 
from  muscular  fibres.  They  give  a  very  large 
statistical  showing  in  its  fiivour.  I  have  seen 
every  kind  of  amputation  there  except  of  the 
hip-joint,  and  never  a  ligature  applied  to  a  large 
vessel.  They  use  no  transverse  forceps,  but 
seizing  the  end  of  the  vessel  with  strong  forceps 
twist  it  until  it  is  felt  to  "  give  way,"  that  is, 
the  two  inner  coats  break.  I  have  often  seen 
six  and  sometimes  ten  complete  turns  given  to 
the  femoral  artery.  Mr.  Bryant  said,  "  Doctor, 
theoretically  the  twisted  end  ought  to  slough 
off,  hat  practically  it  never  does.  We  have  to  talk 
to  our  students  about  secondary  haemorrhage, 
but  we  do  not  show  it  to  them."  Mr.  Lucas 
told  me  that  for  a  long  time  they  have  ceased 
to  dread  or  look  for  secondary  haemorrhage. — 
London  Correspondent,  Boston  Medical  and 
Surgical  Journal. 


Pavesi  on  Chloralated  Tincture  of  Iodine. 
— C.  Pavesi  (Lo  Spallanzani),  to  further  increase 
the  therapeutical  powers  of  the  tincture  of 
iodine,  adds  to  it  chloral,  which  dissolves  in  it 
without  decomposition.  The  resulting  prepara- 
tion has  the  property  of  being  miscible  with 
water  without  precipitating.  The  proportions 
of  its  ingredients  are :  Iodine  (very  pure),  20 
parts;  chloral-hydrate,  30  parts;  spirits  of 
wine,  strength  36,  140  parts.  The  solution 
should  be  filtered,  and  kept  in  an  emery 
polished  bottle.  The  liquid  is  of  pure  golden 
hue,  soluble  in  water,  and  has  an  odour  and 
taste  which  indicates  its  ingredients.  The 
chlorated  tincture  of  iodine,  on  account  of  its 
marked  coagulating  powers  over  albumen,  is  an 
excellent  haemostatic,  and  very  useful  in  the 
treatment  of  large  wounds  as  an  antiseptic  and 
hypnotic, — London  Med.  Record. 


Nerve  Stretching  in  Sciatica. — Billroth 
treats  sciatica  by  subcutaneous  nerve-stretching. 
The  patient  is  placed  flat  upon  his  back,  the 
leg  extended,  and  then  the  thigh  flexed  strongly 
upon  the  trunk.  This  puts  the  sciatic  nerve 
on  the  stretch. — N.  Y.  Medical  Record. 


Iodoform  in  Impetigo  and  Eczema. — Dr. 
Squire  {British  MedicalJoumal),  uses  iodoform 
either  pure  or  mixed  with  an  equal  quantity  of 
[)Owdered  starch ;  the  latter  he  is  inclined  to 
believe,  lessons  the  irritating  action  of  the 
iodoform.  He  first  softens  the  scales  by  bath- 
ing them  with  soap  and  warm  water,  and  then 
completely  removes  them ;  the  new  surface  is 
then  dried  very  gently.  The  iodoform  being 
then  very  thoroughly  powdered  is  dusted  on, 
after  which  glycerine  is  lightly  painted  over 
with  a  camel's  hair  pencil,  which  process  is 
repeated  during  every  two  hours  thereafter, — 
Quarterly  Epitome. 


An  Annular  Variety  of  Tinea  Versi- 
color,— During  an  unusual  prevalence  of  para- 
sitic skin  diseases  observed  in  Hamburg,  during 
the  winter  of  1879-80,  Unna  observed  a  very 
singular  form  of  tinea  versicolor.  The  spots 
would  begin  as  circles.  While  the  periphery 
extended  the  brownish  centre  would  disappear 
and  an  annular  form  be  assumed.  These  rings 
showed  no  disposition  to  run  together.  Though 
the  arrangement  closely  simulated  tinea  ton- 
surans, the  features  of  the  eruption  were  those 
of  tinea  versicolor. —  Viertefj  /.  Derm.  u.  Syph. 
— Archives  of  Dermatology. 


Skin  Grafting. — Dr.  Berger  {British  Medi- 
cal Journal,  November  5th,  1881),  advocates 
a  method  of  exciting  vascularisation  of  the 
flap  before  cutting  it,  by  covering  the  skin 
either  with  a  mustard  plaster,  or  with  warm 
poultices.  He  claims  marked  success  from  this 
method. 

■  ■»■ « 


Collapse  of  an  Ancient  Landmark. — The 
beautiful  old  church  at  Hempstead,  in  Essex, 
the  well-known  resting-place  of  the  remains  of 
the  immortal  Harvey,  has  suddenly  crumbled 
into  atoms  and  become  of  "  the  things  that 
were  and  are  not,  save  in  retrospect."  Dr. 
B.  W.  Richardson,  writing  to  the  London 
Lancet  of  the  4th  "It.,  chronicles  the  event, 
and  makes  appeal  to  the  profession  "  to  join  in 
subscribing  to  the  restoration  of  a  structure 
which,  to  every  true  .^sculapian,  is  of  so  much 
interest." 


9S 


CANADIAN  JOURNAL 


Ptduifcni. 


CAMPBELL  ON  THE  VALUE  OF  QUIN- 
INE IN  OBSTETRICS   AND 
GYNECOLOGY. 

Dr.  H.  F.  Campbell  concludes  an  ex- 
haustive paper  (American  Gyncecol.  Trans.) 
with  the  following  remarks  : — An  exalted  re- 
flex excitability  of  the  cerebro-spinal  centi'es, 
as  well  as  general  plethora,  may  be  recognized 
as  a  chai-dcteristic  condition  of  the  pregnant 
woman  from  the  date  of  conception  to  the  com- 
pletion of  involution.  This  provisionally  in- 
creased development  and  polarity,  intended  for 
foetal  and  uterine  growth,  renders  the  woman 
during  its  continuance  eminently  liable  to  be- 
come the  subject  of  various  morbid  reflex 
actions,  more  or  less  peculiar  to  her  condition. 
These  reflexes  are  of  two  perfectly  distinct  and 
dissimilar  kinds,  differing  widely,  as  they  may 
happen  to  occur,  before  or  after  parturition. 
During  the  entire  period  of  pregnancy,  and 
until  after  labour,  the  reflexes  are  of  excito- 
motory  character,  restricted  to  the  muscular 
apparatus  of  the  uterus  and  of  general  volition. 
They  are  apyrexic  and  non-inflammatory.  Their 
paroxysms  threaten  premature  expulsion  of  the 
fcetus  in  pregnancy,  and  eclamptic  convulsions 
in  labour.  After  parturition,  the  reQexes  are 
of  an  ex ci to- secretory  character.  They  are  pro- 
pagated through  the  ganglionic  or  vaso-motor 
nerves,  to  the  blood-vessels  and  capillaries  of 
the  pelvic  organs  and  tissues  of  the  general 
system.  They  are  marked  by  fever,  congestion, 
and  inflammation,  with  their  products  and  con- 
sequences. Septic  fever  and  peritonitis,  with 
arrest  of  involution  and  mammary  abscess,  are 
their  not  uncommon  results.  Quinine,  by  its 
contractile  action  on  the  capillaries  of  the  cere- 
bro-spinal centres,  exsanguinates  their  nervous 
structure,  and  more  than  any  known  agent  de- 
presses the  reflex  excitability  from  which  the 
varied  morbid  phenomena  of  both  preg- 
nancy and  child-bed  originate.  Quinine,  except 
in  cases  of  idiosyncrasy,  or  from  an  injudicious 
administration  of  the  agent,  exercises  no  in- 
fluence whatever  to  superinduce  premature  ex- 
pulsion of  the  foetus.  Moderate  cinchonism, 
adjusted  to  the  type  and  approach  of  the  par- 


oxysmal neuroses  which  endanger  the  welfare 
of  the  fcfitus  during  pregnancy,  is  one  of  our 
most  efficient  resources  in  many  cases  of 
threatened  abortion  and  of  premature  labour. 
During  parturition,  it  may  give  steadiness  to 
irregular  uterine  contractions  ;  and,  continued 
during  labour,  cinchonism  is  in  a  most  valuable 
degree  prophylactic  against  threatened  eclamp- 
sia. The  reflexes  of  childbed,  pertaining  as 
they  do,  primarily  and  principally,  to  the 
recently  evacuated  uterus — well  likened  to  an 
organ  in  a  traumatic  condition — opportune  and 
ready  for  the  awakening  of  fever  and  inflamma- 
tion, are  of  the  gravest  character,  frequently 
tending  to  disorganization  and  death,  or  else  to 
permanent  and  irreparable  injury.  These  re- 
flexes constitute  a  dreaded  class  of  diseases, 
most  commonly  called  'puerperal,'  which,  by 
universal  consent,  must  bo  prevented  rather 
than  trusted  to  efforts,  often  unavailing,  for 
their  cure.  To  this  end,  the  most  valuable  and 
reliable  prophylactic  method  will  be  found  to 
consist  in  the  daily  administration  of  quinine, 
to  the  degree  of  moderate  cinchonism,  from  the 
day  of  parturition,  to  be  continued  daily  until 
normal  involution  is  safely  secured.  By  the 
observance  of  this  routine,  as  a  rule,  it  is 
believed  that  the  occurrence  of  puerperal 
diseases  will  be  largely  prevented,  and  that  the 
rate  of  childbed  mortality  will  be  greatly 
diminished.  Cinchonism,  in  its  quality  of  pre- 
venting and  controlling  inflammation,  whether 
traumatic  or  idiopathic,  and  of  suppressing  sup- 
puration, all  of  which  is  due  to  its  power  over  re- 
flex excitability  of  the  cord,  and  its  action  on  the 
capillaries,  has  a  claim  to  antiseptic  value 
superior  to  Listerism,  and  isless  to  be  dispensed 
with  than  carbolic  acid,  or  any  of  the  means 
and  appliances  of  th«?  recognised  antiseptic 
method.  In  general  surgery,  and  especially  in 
uterine  surgery,  as  well  as  after  parturition,  the 
combination  of  carbolized  irrigations  and  ap- 
plications to  diminish  peripheral  excitability, 
with  persistent  cinchonism  to  depress  centric 
excitability,  should  constitute  hereafter  an 
antiseptic  method  more  trustworthy,  generally 
practicable,  and  less  to  be  dispensed  with  than 
the  most  faithful  observance  of  the  complex 
Listerian  process.  [While  bearing  willing  tes- 
timony to  the  v.^lue  of  quinine  in  lessening  the 


OF  MEDICAL  SCIENCE. 


93 


mortality,  and  more  especially  the  morbility 
during  the  lying-in  state,  the  reporter  regards 
Listerian  precautions  as  being  at  least  equal  in 
prophylactic  and  therapeutic  power  to  cinchon- 
isra.  In  the  British  Lying-in  Hospital,  the  two, 
Listerism  and  ciuchonism,  go  together,  and  are 
regarded  as  twin  sisters,  the  one  being  the  com- 
plement of  the  other.  In  fact,  the  reporter 
looks  upon  cinchonism,  by  its  power  of  contrac- 
ting the  uterus,  as  an  integral  part  of  the  true 
antiseptic  method.  — London  Medical  Record. 


TEMPERATURE  IN  CHILDBED. 

Dr.  Napier  gives  the  following  conclusions 
on  this  subject  in  the  Edinburgh  Medical 
Journal,  November,  1881  : — 

1.  The  average  temperature  for  a  few  days 
preceding  parturition  is  98.5°  to  99°  :  the  sub- 
sequent heat  is  modified  by  the  hour  of  delivery, 
but  to  only  a  small  extent.  The  healthy  puer- 
peral range  is  2.5°. 

2.  No  temperature  over  99°  (unless  accounted 
for  by  individual  nervous  susceptibility)  is  nor- 
mal after  four  days.  The  healthy  patient  may 
have  an  occasional  night  temperature  of  100°  or 
101°  within  the  first  four  or  five  days,  but  a 
continuing,  or  even  a  morning  or  day  record 
like  this  requires  an  explanation. 

3.  Slight  causes,  e.  g.,  constipation,  retention 
of  urine,  etc.,  give  a  rise  to  99°-100.5°,  some- 
times more. 

4.  Retention  of  clots  or  secundines,  99°-10r, 
or  upwards  ;  103°  at  times. 

5.  Weid  has  a  sudden  late  temperature  of 
103  5°,  with  rapid  pulse  ;  the  heat  falls  quickly 
with  the  development  of  the  local  affection. 
Other  cases  of  mastitis  are  mildly  febrile  for 
several  days. 

6.  Metritis  (endo-  and  peri-)  gives  record  of 
103.5°,  with  slow  pulse. 

7.  Peritonitis  has  a  single  rigor  and  a  sudden 
early  temperature  of  104°  or  upwards ;  the  pulse 
is  wiry.  General  peritonitis,  if  severe,  105.5°- 
106°. 

8.  Pelvic  cellulitis,  oophoritis,  parametritis, 
etc.,  have  a  heat  of  101°-102.5°;  the  pulse  is 
weak  and  irritable.  Recurrent  rigors  mark 
fresh  deposits  of  pus,  and  are  followed  by  tem- 
porary increased  heat,  104.5°. 


9.  Pyaemia  and  uterine  phlebitis  average  103°, 
perhaps  more.  Cases  in  which  the  veins  are 
rapidly  afiected  are  soon  104.5°  to  106°,  and  end 
speedily.  Pyaemia  is  frequently  late  in  develop- 
ment, 7  to  10  days. 

10.  Septicaemia  varies  from  102  5°-107°. 
The  heat  is  never  less,  at  least  for  some  period 
of  the  twenty -four  hours,  than  102.5°,  if  the 
case  is  properly  established.  The  temperature 
is  liable  to  variations,  but  after  the  norm  has 
been  reached  is  less  so  than  pyaemia.  There  is 
no  security  from  remission  till  the  night  tem- 
perature is  under  100°.  Recovery  may  take 
place  after  106°,  but  is  rare. 

11.  Mental  emotion  may  show  104'  or  even 
106°,  and  we  may  sometimes  have  in  addition 
symptoms  resembling  metro-peritonitis.  These 
cases  do  not  persist,  and  are  generally  normal 
in  less  than  forty-eight  hours. 

12.  If  the  temperature  does  not  rise  within 
ten  days  from  delivery,  there  is  little  risk  of 
grave  disease,  unless  from  gross  imprudence  in 
exposure  to  cold,  or  zymotic  infection. 

13.  Although  the  temperature  is  moderately 
low,  100°-10r,  so  long  as  the  pulse  continues 
120  or  more  we  are  not  safe  from  relapse.  No 
anxiety  need  be  felt  so  long  as  the  temperature 
is  kept  under  102°.  However  fast  the  pulse,  if 
the  temperature  continues  low  the  prognosis  is 
favorable.  An  evident  exception  pertains  when 
temperature  is  low  from  collapse.  If  the  tem- 
perature is  persistent  at  102°,  or  frequently 
recurs  to  this  point,  there  must  be  an  abnormal 
organic  condition. 

14.  Temperature  should  be  observed  night  and 
morning  for  the  first  seven  days,  and  daily  for 
three  to  seven  days  after,  more  especially  if  any 
instiumentation  has  been  required  for  delivery, 
or  if  zymotic  or  epidemic  disease  prevails. 
When  an  abnormal  temperature  is  discovered, 
it  should  be  reduced  to  the  normal  as  early  as 
possible  by  one  or  other  agent.  It  is  of  the 
highest  moment  to  bring  it  down  to  100°  and 
keep  it  there  or  lower. — Philadelphia  Medical 
and  Surgical  Reporter. 


Herman  E.  Heyd,  M.D.,  McGill,  of  Brant- 
ford,  Ont.,  was  admitted  M.R.C.S.  on  the  19th 
of  January. 


94 


CANADIAN  JOURNAL 


THEN  AND  NOW. 

At  a  nieoting  of  the  Cincinnati  Acad.  Med., 
Sept.  26tli,  Prof.  Thad.  A.  Reamy,  President, 
nade  the  following  remarks  : — 

Nf arlj  four  thousand  years  ago  JacoVt  leav- 
ing the  scenes  of  family  disgrace,  journeyed  to 
Bethel — where  God  talking  to  him  face  to  face, 
told  him  to  "  be  fruitful  and  multiply,"  pro- 
mising him,  if  obedient,  that  nations,  and  a 
company  of  nations  should  be  of  him,  and  that 
kitigs  should  come  out  of  his  loins.  Jacob 
obeyed,  and  God  kept  his  promise.  This  was 
the  beginning  of  the  greatness  of  Israel.  But 
the  first  case  of  labor  which  occun-ed  after  the 
command  was  fatal  to  the  mother.  Hear  the 
record — "  Rachel  travailed  and  she  had  hard 
labour.  And  it  came  to  pass  when  she  was  in 
hard  labour,  that  the  mid-wife  said  unto  her, 
'  Fear  not,  thou  shalt  have  this  son  also.'  And 
it  came  to  pass  as  her  soul  was  departing  (for 
she  died)  that  she  called  his  name  Ben-oni." 

Who  that  has  read  this  touching  story  of 
Rachel  in  hard  labour  near  Ephrath  has  not 
been  moved  with  sympathy,  and  wished  »that 
instead  of  an  ignorant  mid-wife,  she  had  had 
the  skill  of  an  educated  obstetrician  ?  And  yet 
what  better  skill  could  have  been  offered  at  so 
late  a  date  as  early  in  the  present  century. 

In  1817  a  royal  princess  approaching  her 
confinement  was  prepared  for  the  ordeal  by 
'■lowering  the  organic  strength  with  bleedings, 
aperients,  and  low  diet,"  and  when  the  travail 
came  she  was  allowed  to  remain  fifty-two  hours 
in  hard  labour,  the  child  being  born  dead  and 
the  mother  dying  almost  immediately  after  the 
delivery — and  yet  her  Royal  Highness  Char- 
lotte was  attended  by  men  of  such  great  dis- 
tinction as  Sir  Richard  Croft,  and  Dr.  Baile, 
with  the  eminent  Johu  Sims  in  another  room 
of  the  palace — and  why  1  Because  it  was  then 
thought  that  meddlesome  midwifery  was  bad. 

Since  your  speaker  entered  practice  it  was 
the  rule  in  one  of  the  largest  and  best  managed 
hospitals  in  the  world,  to  prohibit  instrumental 
interference  until  all  hope  of  natural  delivery 
was  at  an  end.  They  had  not  learned  to 
answer  the  question  put  in  his  report  of  1872 
by  the  master  of  the  Rotunda  Hospital,  *'  Why 
should  we  permit  a  fellow-creature  to  undergo 
hours  of  torture  when  we  have  the  means  of 


relieving  her  within  our  I'each  1  "  Now,  how- 
ever, the  answer  comes,  with  the  autlsority  of 
modern  science  and  skill.  Timely  interference 
shall  save  the  life  of  the  child  as  well  as  that 
of  the  mother.  Not  "  meddlesome  "  but  conser- 
vative skilled  interference.  Since  the  modern 
practice  came  into  vogue,  the  mortality  both  to 
mother  and  child  is  so  lessened  that  it  may  be 
said :  yesterday  was  sorrow,  pain  and  death  ; 
to-day  is  joy  and  life. 

I  condemn  not  the  men  of  the  past,  nor  praise 
those  of  the  present,  but  speak  only  of  the 
"science"  and  the  "  art  "  then  and  now.  And 
I  assert  that,  with  anaesthesia,  advanced  know- 
ledge of  the  mechanism  and  the  physiology  of 
labour,  and  the  consummate  skill  now  brought 
to  instrumental  cases,  the  new  graduate  of 
any  reputable  medical  college  of  to-day  could 
have  successfully  delivered  Rachel  on  the 
plains  of  Edar,  or  Charlotte  in  the  royal  palace. 
— Quarterly  Epitome. 


CHLORAL  IN  LABOUR. 

Some  observations  on  this  are  reported  in  the 
St.  Louis  Courier  of  Medicine.,  by  Dr.  B. 
Bribach  : — 

The  mode  of  exhibiting  the  drug  consisted 
in  giving  fifteen  grains  every  half  hour  until 
the  patient  came  under  its  full  influence ;  in 
unusual  rigidity  of  the  oa,  thirty  grains  were 
given  as  the  initial  dose.  The  total  amount  in 
each  instance  varied,  from  thirty  to  seventy-five 
grains  being  sufficient  in  the  majority  of  cases. 
To  a  few  patients  thirty  grains  were  given  by 
enema  ;  in  the  parturient  state  chloral  appears 
to  act  even  more  promptly  and  satisfactorily 
when  given  by  the  rectum  than  it  does  when 
given  by  the  mouth. 

Effect  on  the  Pains. — Chloral  modifies  the 
dilating  pains  of  the  first  stage,  in  so  far  that 
it  renders  them  decidedly  less  frequent,  more 
effective,  and  less  harassing  to  the  patient. 
Pains  occurring  every  five  minutes  will,  after 
the  exhibition  of  the  chloral,  generally  recur 
less  frequently,  about  every  ten  minutes.  The 
teasing,  wearing  sensation  in  the  interval 
between  the  pains,  with  its  suffering  and  the 
lamentations  of  the  patient  subside,  giving  way 
to  a  state  of  peaceful  somnolence.     During  the 


OF  MEDICAL  SCIENCE. 


95 


pains  the  patient  is  aroused,  but  the  expres- 
sions of  pain  and  worry  are  much  less  marked. 
The  eflfect  is  often  so  very  striking  that  the 
parturient  process  seems  to  be  entirely  sus- 
pended. Digital  examination  during  the  pains, 
however,  shows  the  uterine  contractions  to  have 
increased  in  efficacy,  from  the  more  powerful 
protrusion  of  the  amnion  and  the  rapid  progress 
of  the  first  stage. 

Effects  on  the  Os  Uteri. — Chloral  has  the 
indubitable  property  of  overcoming  functional 
rigidity  of  the  os.  In  some  instances  the 
rapidity  of  its  action  is  surprising.  The  pre- 
sence of  fecal  matter  in  the  lower  bowels  seems 
to  counteract  the  action  of  chloral. — Quarterli/ 
Epitome. 


Removal  of  the  Whole  Uterus  for  Can- 
cer.— The  entire  uterus  was  removed  for  cancer 
on  January  3rd,  in  St.  Thomas'  Hospital,  by 
Sir  William  MacCormac.  The  patient  is  a 
woman  of  thirty-four.  She  was  admitted 
under  Dr.  Ord's  care  for  obstinate  constipation 
and  signs  of  intestinal  obstruction.  A  cancer- 
ous mass  involving  the  cervix  uteri,  together 
with  a  tumour  pressing  on  the  rectum,  were 
discovered.  The  method  of  abdominal  section 
was  selected,  and  as  soon  as  the  peritoneal 
cavity  was  exposed,  the  pelvis  was  found 
blocked  by  a  tense  fleshy  everywhere  adherent 
cyst,  which  compressed  the  rectum  against  the 
sacrum,  and  completely  concealed  the  uterus 
and  its  appendages.  In  order  to  obtain  space 
the  cyst  was  punctured,  and  found  to  contain 
very  oflPensive  pus,  some  of  which  it  was  im- 
possible to  prevent  entering  the  pelvic  cavity. 
The  adhesions  were  then  separated,  and  the  cyst, 
which  is  probably  ovarian,  removed  with  the 
uterus  and  ovaries.  No  attempt  was  made  to 
stitch  up  the  vagina  or  pelvic  reflections  of  the 
peritoneum.  A  large  double-barrelled  "P-shaped 
drainage-tube  was  inserted,  the  end  projecting 
from  the  vagina,  and  left  in  the  cavity  of  the 
abdomen;  this  was  used  for  frequent  irrigation. 
Five  days  after  the  operation  the  temperature 
rose  to  102"6°.  There  was  some  evidence  of 
suppuration  opposite  the  lower  extremity  of 
the  abdominal  incision.  Sir  William  Mac- 
Cormac broke  down  the  already  adherent  edges 
of  the  wound ;  some  pus  escaped,  and  the  ca- 


vity has  since  been  daily  waihed  out.  Shortly 
after  this  the  temperature  fell  to  99°,  and  at 
present,  ten  days  after  the  operation,  the 
patient's  condition  is  excellent,  and  promises  a 
speedy  convalescence.  There  has  been  no  general 
peritonitis.  Eucalyptus  lotions  and  dressings 
were  employed.  [The  patient  has  since  com- 
pletely recovered. — Ed.] 


Weil  on  the  Results  of  the  Examination 
OF  the  Hearing  in  4,500  School  Children. 
— The  following  are  some  of  the  conclusions  at 
which  Dr.  Weil  of  Stuttgart  has  arrived  from 
the  examination  of  the  above  large  number 
of  children.  The  normal  ear  hears  whispered 
speech  of  medium  intensity  at  a  distance  of 
66  to  82  feet  amongst  sufficiently  quiet  sur- 
roundings. Impairment  of  hearing  is  of  very 
common  occurrence.  In  the  national  schools 
(Volksschulen)  the  hearing  of  as  many  as  30 
per  cent,  of  the  children  was  defective.  This 
percentage  is  less  in  children  of  the  better 
classes;  e.g.,  in  the  Catharinenstift  it  was  only 
about  10  per  cent.  The  percentage  increases 
with  the  age.  Perforation  of  the  membrana 
tympani,  with  suppuration,  was  found  in  2  per 
cent,  of  the  children ;  plugs  of  cerumen  or 
commencement  of  the  same,  in  13  per  cent. 
Most  ot  the  children  had  never  been  under 
treatment,  and  many  had  not  the  least  idea 
of  their  affliction ;  not  a  few  being  considered 
inattentive,  and  probably  treated  accordingly. 
This  corroborates  the  proposition  previously 
enunciated  by  the  author,  viz.,  that  every 
inattentive  child  sliould  be  examined  as  regards 
its  hearing  power.  The  author  recommends 
that  in  schools,  at  the  beginning  of  every  term, 
the  master  should  test  his  pupil's  hearing, 
which  can  be  done  without  much  trouble  and 
loss  of  time.  By  this  plan  alone  is  it  possible 
to  prevent  children  from  being  misjudged. — 
London  Medical  Record. 


KONIGSTEIN  ON  THE  EyES  OF  NeW-BORN  CHIL- 
DREN.— Through  the  kindnessof  Prof.  Sjjath,  the 
author  was  enabled  to  examine  the  eyes  of  the 
children  of  the  second  lying-in-clinic,  and 
reports  (  Med.  Jahr.  der  K.  K.  Geasel.  der  Aerzte 
zu  Wien.  1881)  the  following  conclusions.-  1. 
The  eye  of  the  child  is  probably  exclusively 
hypermetropic.  2.  The  colour  of  the  child's 
ii-is  is  not  invariably,  buj;  frequently,  blue.  3. 
The  diff'erence  in  breadth  and  appearance  be- 
tween the  retinal  arteries  and  veins  is  not 
so  groat  as  in  adults.  4.  In  a  great  many 
cases  remains  of  the  pupillai*y  membrane  are 
to  be  found,  and  in  10  per  cent,  there  are 
extravasations  of  blood  in  the  retina. — London 
Medical  Record. 


96 


CANADIAN  JOURNAL 


OJarrfSjiourtfnrr. 


To  the  Editor  of  the  Cakadiam  Journal  of  Mbdical  Sciikcb. 

Sir, — Fearing  that  somtt  of  your  readers 
have  not  received  a  copy  of  the  1881-82 
Council  announcement,  and  that  they  have 
thus  lost  the  following  treat  is  my  apology  for 
desiring  to  occupy  your  space  : 

"  THEORY  AND  PRACTICE  OF  MEDICINE. 

HOMEOPATHIC. 

"  1.  State  the  dogma  which  distinguishes 
the  Homoeopathic  School  of  Medicine  from  all 
others. 

"  2.  Do  you  accept  this  dogma  as  a  mere 
sentiment,  allowing  departure  therefrom  as 
may  suit  your  convenience,  or  as  a  principle 
by  which  to  govern  your  whole  practice,  and 
to  be  maintained  at  all  cost? 

"  3,  What  medical  work  does  our  School 
acknowledge  alone,  for  the  annunciation,  ex- 
position, application,  and  defence  of  this  funda- 
mental doctrine  1 

'*  4.  What  other  works  have  we  from  the 
same  pen  to  indicate  the  practical  application 
of  the  doctrine  1 

"  5.  State  Hahnemann's  views  of  what  are 
the  three  great  sources  of  chronic  disease  in 
the  human  family. 

"  6.  Which  of  the  three  does  he  regard  as 
most  extensive  in  its  baneful  effects? 

*'  7,  What  causes  or  conditions  may  exist 
to  retard  the  curative  action  of  a  properly 
chosen  remedy  'i 

"  8.  When  two  or  more  remedies  seem  to 
be  equally  indicated  by  the  prominent  symp- 
toms in  a  given  caje — say  j)leuro-pneuraonia 
of  the  left  lung — how  will  you  select  the  one 
homoeopathic  to  the  disease  1 

"  9.  In  any  future  case  of  similar  disease, 
how  far  will  your  clinical  experience  in  the 
former  justify  you  in  again  selecting  the  same 
remedy  1 

"  10.  What  is  our  rule  for  selecting  the 
remedy  1 

"J.  Hall,  M.D.,  Examiner." 

Would  some  member  of  the  Council  give  us 
information  upon  a  lew  points? 

Ist.  Does  the  Council  endeavour  to  increase 
the  usefulness  and  uphold  the  dignity  of  the 
profession  in  Ontario  1 

2nd.  Is  the  above  paper,  submitted  at  one 
of  its  final  examinations,  and  printed  in  its 
announcement,  likely  to  assist  in  such  en 
deavours 1 

3rd.  Does  it  not  seem,  from  the  "  inexpen- 
sive method  "  adopted  in  the  admitting  of  one 
Uall  to  registrtition,  and  from   the  style  of 


Huoh  examiuatioa  papers  as  the  above  that  for 
homoeopathic  students  is  shown  much  more 
consideratii  n  than  for  regular  students. 

4th.  Is  it  possible  that  learned  members  of 
the  Council,  who  are  seeking  some  office  for 
the  future,  support  such  moves  as  the  "  inex- 
pensive method"  in  order  to  gain  votes  in  the 
event  of  a  contest  1 

dth.  Is  it  not  a  studied  insult  to  refuse  the 
graduates  of,  say,  Toronto  University  registra. 
tion,  and  at  the  same  time,  to  register  the 
aforesaid  Hall  by  that  "  handy  and  inexpen- 
sive method,"  or  to  register  a  homoeopathic 
Student  after  passing  such  an  apology  for  an 
examination  as  the  above  paper  offers  1 

Regular  students  do  not  ask  to  have  their 
examinations  shaped  after  such  a  model  as  the 
1881  homoeopathic  medicine  paper,  but  they 
do  ask  that  no  man  be  allowed  to  register  as  a 
practitioner  in  Ontario  unless  he  fulfill  the 
requirements  which,  without  an  exception, 
they  are  required  to  fulfill,  and  pass  decent 
examinations  upon  all  the  subjects  upon  which 

they  are  required  to  pass. 
I  am.  Sir, 

Yours  truly, 

Medicus. 

t^*m  ■ 

To  the  Editor  of  the  Canadian  Journal  of  Medical  Sciekcb. 

I  had  not  intended  to  take  the  slightest 
notice  of  the  letter  in  youi  last  number,  signed 
"  Medicus,"  written,  every  one  says,  as  no 
secret,  by  Dr.  Bergin,  President  of  the  Council. 

The  Dr's.  alleged  facts  are  incorrect,  and  his 
deductions  are  equally  so. 

It  is  particularly  unfortunate  that  such  a 
letter,  emanating  from  such  a  source,  should 
have  been  written,  as  it  leads  to  distrust  of  the 
Council  on  the  part  of  the  young  men.  And  if 
it  be  the  right  thing  for  any  one  who  presides 
over  the  Council  to  attack  one  of  our  schools 
today,  it  would  be  equally  right  to  assail 
another  to-morrow,  and  it  is  not  difficult  to  see 
the  consequences  of  such  a  course. 

Coarsely  abusing  young  men  in  the  Council 
one  year,  and  writing  a  bitter  letter  with  the 
view  of  injuring  one  of  our  schools,  just  on  the 
eve  of  the  examination  of  the  next,  is  a  very 
short-sighted,  and  very  foolhardy  policy  to  say 
the  least,  i.e.,  so  far  as  the  best  interests  of  the 
Council  are  concerned. 

W.  B.  Geikie. 

[The  writer's  assumptions  are  gratuitous ; 
the  facts  such  as  to  require  more  specific  refuta- 
tion.— Ed.] 


OF  MEDICAL  SCIENCE. 


97 


THE  CANADIAN 

|onritii(  oi  l|eli(iti  |ritit((, 

A  Monthly  Joarnal  of  Medical  Science,  Criticism, 
and  News. 

To  Correspondents. —  We  shall  begladtore- 
ceivefrom  our  friends  everywhere,  current  medical 
news  oj  (general  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwardins;  reports  of  the  proceedings  of  their 
Associations. 

TORONTO,  MARCH,  1882. 

CONSULTATIONS  WITH  HOMCEO- 
PATHS. 

It  is  with  sincere  pleasure  that  we  have 
received  a  personal  denial,  from  the  gentleman 
chiefly  concerned,  of  the  allegations  contained 
in  onr  last  issue  as  to  his  reported  meeting 
two  homoeopaths  in  consultation. "  He  informs 
us  that  one  Hahnemannian  practitioner  was 
certainly  present,  and  witli  his  consent,  at  his 
examination  of  the  patient,  but  merely  for  the 
express  purpose  of  stating  what  he  had  pre- 
viously observed  (while  in  attendance  upon  the 
case)  just  as  an  ordinary  layman  might  have 
done,  and  that  no  consultation  or  other  com- 
munication was  had  with  him,  but  the  opinion 
of  the  surgeon  was  expressed  directly  to  the 
friends.  The  presence  of  another  homoeopath 
in  the  house  at  the  time  was  a  mere  matter  of 
coincidence,  and  for  the  purpose  of  seeing 
another  patient  altogether. 

This  explanation  suggests  a  further  diffi- 
culty. Is  it  advisable  that  we  should  receive 
information  as  to  the  patient's  previous  condi- 
tion from  such  a  source  %  We  trow  not ;  but 
deem  it  better  to  seek  such  assistance  from 
any  intelligent  layman,  and  thus  avoid  the 
aj)pearance  of  evil. 

It  cannot  be  denied,  and  it  is  useless  to  shut 
our  eyes  to  the  fact,  that  there  is  a  growing 
disposition,  in  some  quarters,  to  overlook  the 
scientific  heresy  or  shibboleth  of  similia  sivi- 
ilibus  as  a  universal  law  of  therapeutics,  and 
to  take  back  its  misguided  utterers  into  the 
fold  of  professional  communion.  But,  surely, 
"  the  times  aie  out  of  joint "  most  strangely 


when  a  medical  society  representing  the  pro- 
fessional dignity  and  intelligence  embodied  in 
that  of  the  State  of  New  York  can  by  a  two- 
thirds  majority  adopt  a  code  of  ethics  ex- 
pressly abandoning  the  clauses  which  forbid 
participation  in  the  farce  of  consultation  with 
the  dogmatists  of  any  exclusive  therapeutic 
sect  or  school ;  and  when  a  medical  journal 
of  the  standing  and  previous  respectability  of 
the  New  York  Medical  Record  can  be  found 
not  only  to  connive  at,  but  to  defend  the 
action.  We  reproduce  the  new  code  of  ethics 
of  this  Society  in  another  place.  The  manlier 
declaration  of  the  abnegation  of  all  tests  of 
fitness  for  fellowship  expressed  in  the  amend- 
ment of  Dr.  Daniel  B.  St.  John  Koosa, 
although  eliciting  a  vote  of  39  to  37  was  lost 
for  want  of  a  two-thirds  majority.  Now,  how 
in  the  name  of  honesty  can  such  things  be? 
The  defenders  of  the  course  pursued  assert  that 
one  by  one  the  three  fundamental  doctrines  of 
the  author  of  the  "  Novum  Organon  "  have 
been  abandoned  by  his  disciples,  and  conse- 
quently there  no  longer  exists  any  difference 
between  them  and  rational  physicians.  We 
admit  the  proposition  readily  for  homoeopathy 
has  aptly  been  defined  "  the  most  preposterous 
delusion  which  ever  took  possession  of  the 
human  mind,"  and  we  cannot  conceive  of  in- 
telligent and  thinking  men  remaining  long 
beneath  the  domination  of  its  thrall.  But, 
granting  this,  who  is  the  fitter  for  association 
with  the  seekers  after  truth, — the  innocent 
dupe  who  honestly  believes  the  prepostei'ous 
nonsense  of  his  creed,  or  the  cunning  knave 
who  has  both  the  wit  to  see  the  inanity  of  his 
professions,  and  the  turpidity  to  dare  to  trade 
with  unblushing  effrontery  upon  the  credulitv 
of  his  fellow  men  1  The  Royal  College  of  Physi- 
cians has  l)een  censured  by  the  Lancet  for  its 
mild  and  half-hearted  protest  against  the  spread 
of  this  virulent  ulcer  on  the  face  of  the  profes- 
sion ;  and  shall  not  a  new  world  journal  speed 
its  winged  words  to  wake  the  sleeper  to  the 
danger  and  the  duty  of  the  hour,  the  festering 
sore  being  poulticed  when  it  should  be  ex- 
cised 1  The  Medical  News  thus  eloquently 
proves  equal  to  the  occasion,  "  There  has 
been  on  the  part  of  regular  physicians  no 
spirit  of  proscription  against  those  irregulars 


98 


CANADIAN  JOURNAL 


who  would  abjure  their  special  creed  and  trdde 
designations,  and  rank  themselves  as  physicians 
only.  The  warfare  has  been,  not  against  the 
consciences  of  men,  not  against  the  riglit  to 
treat  diseases  according  to  their  convictions  of 
the  utility  of  therapeutical  measures  It  is 
the  parading  of  a  special  designation,  the 
offensive  proclamation  of  '  siinilia  similihus ' 
as  the  trade  insignia,  against  which  the  great 
body  of  tho  medical  profession  has  protested 
and  will  continue  to  protest.  All  the  glitter- 
ing generalities  which  are  i;ow  uttered  to  con- 
ceal the  real  point  at  issue,  the  authority  of 
great  names,  and  the  momentary  outburst  of  a 
humanitarian  sentiment  in  a  great  medical 
society,  will  not  blind  the  thinking  men  of  the 
profession. 

"  To  yield  the  point  of  the  right  to  consult 
with  all  kinds  of  irregulars  who  hafipen  to  be 
'  legally  qualified  practitioners,'  is  to  admit 
that  the  regular  medical  profession  has  hitherto 
occupied  a  false  position. 

"  To  yield  the  point,  is  to  admit  that  they 
who  have  maintained  the  truth  of  one  exclu- 
sive dogma,  and  have  practised  on  a  trade 
designation,  were  right,  and  those  who  opposed 
them  were  wrong. 

"To  yield  the  point,  is  to  strengthen  all 
irregular  practitioners  in  their  position  of 
bigoted  intolerance,  and  to  confuse  and  dis- 
may the  disciples  and  friends  of  legitimate 
medicine.  We  do  not  believe  that  the  medical 
profession  will  thus  stultify  themselves,  but 
that  they  will  more  energetically  than  before 
reaffirm  the  great  principles  for  which  they 
have  steadfastly  contended." 


At  the  late  Meeting  of  the  New  York  State 
Medical  Society,  in  Albany,  Drs.  .lohn  Guerin, 
Cayuga;  D.  V.  O'Leary,  Albany,  L.  E.  Felton, 
St.  Lawrence;  and  C.  C.  Dodge,  of  Clinton,  were 
apiK)inted  delegates  to  the  Canada  Medical 
Association.  Now,  although  there  can  be  no 
shadow  of  doubt  but  that  these  gentlemen,  per- 
sonally, would  receive  a  most  cordial  welcome 
from  our  Dominion  Association,  yet,  we  opine, 
there  are  grave  reasons  to  believe  that  it  is  a 
fair  subject  for  dubitation,  as  to  the  competency 
of  our  Association  to  receive  delegates  from  a 
body  adopting  the  code  of  Ethics  now  prevail- 
ing in  the  New  York  State  Medical  Society. 


THE  MEDICAL  COUNCIL  OF  ONTARIO. 

Has  the  Medical  Council  proved  a  failure  t 
We  hope  not,  although  it  would  certainly 
puzzle  its  best  friends  to  defend  some  of  its 
very  extraordinary  acts.  1  f  there  live  in  the 
Province  any  member  of  the  regular  Profession 
who  will  endorse  all  the  proceedings  of  the 
last  Session,  we  have  neither  seen  nor  heard 
of  him.  A  correspondent  in  this  issue  refers 
to  the  "inexpensive  method"  by  which  a 
homoepathist  of  this  city  was  granted  a  license, 
after  undergoing  some  peculiar  farce  known  as 
a  cheap  examination,  while  a  number  of  very 
worthy  students  were  j)lucked,  and  rather 
unmercifully  sat  upon  at  the  same  time.  We 
have  referred  to  this  matter  before,  and  have 
no  desire  to  give  it  too  much  prominence ;  but 
it  leads  to  a  broad  and  very  important  ques- 
tion :  Are  the  homoepaths  masters  of  the 
situation  ]  Do  they  practically  rule  the 
Council  1  It  has  been  f  i-eely  stated  on  different 
occasions  in  tho  past,  by  men  who  ought 
to  know,  that  such  is  the  case.  If  such  has 
been  the  condition  of  affairs,  it  has,  of  course, 
been  brought  about  by  divisions  in  the  ranks 
of  the  regulars,  arising  very  often  simply 
through  petty  personal  jealousies,  enmities, 
and  ambitions,  while  the  other  party  have 
kept  together  in  a  compact  body,  and  played 
their  cards  skilfully  by  always  voting  with 
those  who  make  the  highest  bid  for  their 
support.  We  hare  no  desire  to  say  anything 
harsh  about  Homoepaths,  as  the  laws  of  our 
country  give  them  a  legal  status  and  a  large 
representation  in  the  Council,  and  they  are 
entitled  to  simple  justice  in  the  matter  of 
examinations  as  well  as  other  things,  but, 
if  you  please,  nothing  more.  In  fact,  we  do 
not  even  blame  them,  but  would  rather  censure 
those  who  have  been  sent  to  represent  the 
great  body  of  the  Profession,  but  have  very 
frequently  wofully  misrepresented  them.  The 
medical  men  of  Ontario  would  do  well  to 
watch  carefully  the  acts  of  their  representa- 
tives, and  either  call  on  them  to  explain 
satisfactorily  some  of  their  objectionable  votes, 
or  send  better  men  to  fill  their  places. 

We  believe  that  the  Profession  is  generally 
anxious  to  sustain  the  Council  which,  with  all 
its  imperfections,  has  done  much  to  raise  the 


OF  MEDICAL  SCIENCE. 


d9 


standard  of  medic  il  education  in  this  Province. 
It  has  given  us  a  central  examining  board, 
which  is  one  of  the  greatest  safeguards  that 
we  can  possibly  have.  The  history  of  the  past 
in  this  and  other  countries  has  proved  con- 
clusively that  it  is  not  safe  to  place  the 
licensing  power  in  the  hands  of  medical  teach- 
ing institutions.  The  inevitable  tendency 
appears  to  be  in  some  of  them  to  pass  every- 
body who  takes  the  regular  course  and  pays 
his  fees.  The,  medical  schools  are,  we  think, 
well  satisfied  with  this  feature  of  the  Council, 
as  there  is  probably  not  one  of  them  that 
is  afraid  to  send  its  students  before  a  central 
board,  where  they  will  compete  on  common 
ground  with  all  who  wish  to  obtain  the 
Ontario  license.  There  is  at  the  same  time  no 
doubt  that  the  Profession  at  large  appreciates 
very  highly  this  feature,  and  would  dislike 
very  much  to  go  back  to  the  old  regime. 

All  things  considered,  we  may  conclude  that 
the  Council  is  not  a  failure,  but  we  cannot  look 
upon  it  as  a  grand  succes  ;  and  yet  it  ought  to 
be  a  success,  and,  wherein  it  has  failed,  we 
must  hold  the  mevnbers  of  the  Council  (in- 
cluding both  present  and  past)  responsible. 


ONTARIO  VETERINARY  COLLEGE. 

This  institution  has  during  the  last  few  years 
advanced  with  wonderfully  rapid  strides,  and 
now  occupies  the  place  of  one  of  the  most 
valuable  educational  institutions  of  the  country. 
At  the  very  successful  dinner  given  at  the 
Walker  House,  January  27th,  we  were  pleased 
to  notice  the  large  number  of  intelligent 
students,  young  men  from  all  parts  of  the  con- 
tinent, who  are  evidently  thoroughly  in  earnest 
in  their  desire  to  obtain  a  scientific  knowledge 
of  the  important  subject  of  veterinary  surgery. 
The  President  is  certainly  to  be  congratulated 
upon  the  distinguished  success  which  has 
attended  his  untiring  efforts.  From  his  speech 
delivered  at  the  dinner,  and  those  of  the  other 
professors,"  we  gathered  the  following  particu- 
lars respecting  the  history  of  the  College. 

The  first  veterinary  instruction  ever  given 
in  this  province,  was  a  short  course  of  lectures 
on  the  subject  in  the  winter  of  1862.  These 
were  delivered  to  a  few  agricultural  students 


by  Mr.  Andrew  Smith,  V,S.,  of  the  Edinburgh 
Veterinary  College,  who  had  been  induced  to 
come  to  this  country  for  that  purpose  by  the 
late  Hon.  Adam  Ferguson  and  Professor 
Buckland.  It  was  not  until  1864,  however, 
that  the  school  was  organized.  In  that  year  a 
regular  course  of  instruction  was  commenced, 
and  attended  by  four  or  five  young  men  who 
purposed  devoting  themselves  to  the  study  of 
the  subject.  The  lectures  were  given  in  the 
Agricultural  Hall,  corner  of  Queen  and  Yonge 
Streets,  while  the  stables  and  infirmary  were 
on  Temperance  Street,  being  part  of  the 
premises  now  occupied  by  the  College  build- 
ings. Gradually  the  number  of  students  in- 
creased until,  in  1861),  a  portion  of  the  present 
building  was  erected,  some  forty  students  being 
in  attendance.  This  building,  then  thought  to 
be  ample  in  size  to  accommodate  the  students 
for  years  to  come,  was  soon  crowded,  and  in 
1876,  Professor  Smith,  having  received  a 
small  grant  from  the  Ontario  Government, 
erected  the  present  College  buildings.  These 
consist  of  a  very  large  lecture-room,  museum, 
dissecting-room,  waiting-room  for  students, 
offices,  and  private  rooms,  together  with  spa- 
cious stables,  <kc. 

From  the  time  of  the  opening  of  the  new 
buildings,  progress  has  been  rapid.  Year  by 
year  witnesses  larger  classes  of  students  attend- 
ing. 

This  year's  entering  class  numbers  69  ;  the 
total  number  attending  the  session — 1881-82,  is 
132.  The  students  come  from  every  part  of 
the  United  States,  Canada,  and  even  a  few 
from  Britain.  The  course  extends  over  two 
winter  sessions,  the  intervening  summer  is  to 
be  spent  in  actual  practice  with  a  regularly 
qualified  veterinary  surgeon.  While  at  College 
the  students  see  and  assist  in  the  large  practice 
of  Professor  Smith,  also  receiving  practical  in- 
struction in  the  dissecting-room,  veterinary 
pharmacy,  tfcc. 

The  names  of  the  lecturers  with  their  subjects 
will  give  a  partial  idea  of  the  scope  of  the 
course  : — Professor  Smith,  Veterinaiy  Medicine 
and  Surgery;  Professor  Buckland,  Breeding  and 
Management  of  Farm  Animals;  Dr.  Barrett, 
Physiology;  Dr.  Thorburu,  Materia  Medica; 
Dr.  Ellis,  (Lectures  given  in  the  School  of 
Science)  Chemistry ;  Mr.  J.  T.  Duncan,  Ana- 
tomy and  the  Use  of  the  Microscope. 


100 


CANADIAN  JOURNAL 


NEWSPAPER    OFFENCES    AGAINST 
THE  PROFESSION. 

Our  attention  has  been  repeatedly  called 
to  the  appearance  in  The  I'iines,  published  in 
Woodstock,  amongst  the  "  Local  and  General " 
items  of  notices  of  accidents  or  injuries  speci- 
fying their  character  and  naming  the  surgeon 
in  attendance,  as  well  as  the  treatment  jjursued. 
In  the  last  two  instances,  Dr.  McLay  has  been 
the  unfortunate  practitioner  to  be  thus  offen- 
sively publicly  advertised,  or  pilloried ;  and 
since  the  general  protest,  which  we  issued  some 
months  ago  against  the  custom  (which  would 
indeed  be  "  more  honoured  in  the  breach  than 
the  observance  ")  seems  to  have  been  lost  upon 
some  of  our  brethren  of  the  secular  press, 
we  deem  it  to  be  the  bounden  duty  of  the 
local  practitioners,  where  such  breaches  of 
professional  decency  prevail,  in  self-defence  to 
make  a  personal  request  to  the  editors  of  such 
papers  to  exercise  such  a  supervision  over  the 
matter  gaining  access  to  their  columns  as  shall 
prevent  the  appearance  of  these  distHsteful  and 
objectionable  items.  Editors  should  be  made 
to  understand  that  we  do  not  court,  but  on  the 
other  hand  shun,  publicity  in  the  discharge 
of  cur  daily  duties,  the  charactei-  and  suttjects 
of  our  work  being  purely  private  ;  and  that 
any  suspicion,  however  slight,  of  a  desire  to 
obtain  vulgar  notoriety  in  the  public  prints, 
savours  too  much  of  charlatanry  to  be  con 
sonant  with  the  scientific  spirit,  and  com- 
promises our  position  in  the  esteem  of  our 
professional  brethren. 

Medicine  is  not  a  trade  ;  and  a  doctor's  qual- 
ifications and  attainments  cannot  be  appraised 
by  popular  favour  or  the  uninitiated  and  un- 
skilled j  udgment.  A  physician's  confreres  can 
alone,  therefore,  estimate  his  leal  worth  ;  and 
no  amount  of  pecuniary  profit  or  general  eslt  em 
can,  therefore,  compensate  him  for  depreciation 
in  the  minds  of  his  compeers. 

The  number  of  the  Arthur  Enterprise  for 
26th  January,  which  lif  s  before  us,  likewise 
contains  an  eff"usion  fiom  one  Francis  Moriis 
of  Peel,  detailing  the  particulars  of  his  suffer- 
ings from  urinary  calculus,  and  narrating  how 
he  obtained  relief  by  placing  himself  in  the 
hands    of    Dr.     McKinnon    in     the     Guelph 


Hospital.  We  are  sure  that  Dr.  McELinnon 
and  his  assistants,  Drs.  Howit  and  Wallace, 
will  be  gratified  to  learn  from  such  a  sourco 
that  the  operation  was  "  most  skilfully  per- 
formed," and  will  be  delighted  to  do  as  much  for 
all  those  who  adopt  the  writer's  advice  to 
"apply  to  them  for  assistance." 

We  know  Dr.  McKinnon  too  well  to  believe 
for  one  moment  that  he  had  any  concurrence 
or  privity  in  the  matter,  but  we  cannot  refrain 
from  mentioning  it,  in  order  to  impress  upon 
his  mind  the  fact  that  in  making  an  accusation 
in  our  columns  a  short  time  ago  of  similar 
impropriety  against  Dr.  Groves,  of  Fergus,  he 
may  possibly  have  judged  an  unoffending 
brother  harshly,  and  that,  therefore,  a  retribu- 
tive Nemesis  treads  upon  his  heels.  For  our 
own  part,  we  much  regret  that  patients  in  the 
west,  with,  doubtless,  the  best  intentions, 
should  endeavour  to  show  their  gratitude  to 
their  healers  in  such  a  profitless  and  objection- 
able way. 

.M»»    » 

THE    ABORTIVE    TREATMENT    OF 
FELON  WITH  COPAL  VARNISH. 

Dr.  A.  B.  Isham,  of  Cincinnati,  bears  testi- 
mony to  the  value  of  this  method  in  a  recent 
number  of  the  Medical  News.  The  plan  was 
suggested  by  an  old  darkey  in  the  vicinity,  and 
consists  in  wrapping  the  affected  part  in  flannel 
bandages  saturated  with  copal  varnish  and 
covered  with  dry  flannel  envelopes  externally. 
Thirteen  cases  have  come  under  observation  in 
the  past  year.  In  six,  suppuration  having 
already  occurred,  incision  was  resorted  to ;  in 
the  remaining  seven,  the  copal  varnish  was  the 
only  agent  used.  The  thumb  was  involved  in 
two  capes,  the  index  in  five.  "  In  all  there  was 
swelling,  redness,  heat,  and  great  pain  ;  iti  one 
a  vivid  erysipelatous  blush  extended  over 
thumb,  wrist,  and  extensor  surface  of  forearm  ; 
in  two  cases  thei-e  was  ap[)arently  a  combina- 
tion of  what  is  popularly  called  '  run-around,' 
with  felon  of  the  flexor  digital  surface,  about 
and  near  the  point.  Perhaps  in  none  was  the 
periosteum  involved,  though  several  did  not 
difier  from  cases  I  have  seen  in  the  acute  stage, 
where  necrosis  and  extrusion  of  the  terminal 
phalanx  subsequently  took  place.  In  all  the 
seven  cases  there  was  a  rapid  subsidence  of  the 


OF  MEDICAL  SCIENCE. 


101 


inflamiuatory  process  and  its  accouipaninients, 
and  by  the  second  or  third  day  the  parts  were 
perfectly  normal.  If  the  varnish  upon  the 
dressings  become  unpleasantly  hard  by  drying, 
it  may  be  softened  by  adding  fresh  material 
from  time  to  time.  Its  removal  may  be  easily 
accomplished,  when  found  desirable,  by  rubbing 
in  lard  and  then  washing  with  soap  and 
water." 

Copal  varnish  consists  of  copal  resin  and 
spirits  of  turpentine,  the  latter  coniStituting 
about  three-fourths  of  the  mixture  ;  and  Dr. 
Isham  suggests  the  following  modus  operandi  : 
1.  B^  an  irritant  action  due  to  the  contained 
turpentine  the  inflammatory  stasis  in  the 
tissues  is  overcome  ;  2.  Bi/  withdrawing  oxygen 
and  arresting  oxidation  the  turpentine  checks 
cell  proliferation,  liquefies  inflammatory  pro- 
ducts, and  renders  parasitic  microphytes  inert ; 
and  3.  By  excluding  air  and  by  pressure.  The 
varnish,  of  course,  is  impermeable  by  air,  an. I, 
in  drying,  it  contracts,  producing  pressure 
which  "  modifies  the  supply  of  blood,  promotes 
the  removal  of  waste  matters,  and  tends  to 
maintain  a  steady  and  continuous  stream." 


TORONTO  SCHOOL  OF  MEDICINE 
MEDICAL  SOCIETY. 

At  the  regular  meeting  of  this  Society  on 
Friday  evening,  February  17th,  Mr.  S.  Stewart, 
B.A.,  read  a  very  interesting  paper  on 
Bacteria. 

On  Friday  evening,  February  24th.  Dr.  J.  H. 
Richardson  delivered  a  very  able  address  on 
the  subject :  "  Science  Falsely  So-called "  to 
the  same  Society.  The  large  audience  listened 
with  great  interest,  as  shown  by*  frequent  and 
hearty  applause,  and  at  the  close  a  very  cordial 
vote  of  thanks  was  given  to  the  Doctor.  This 
flourishing  young  society  is  showing  remarkable 
vigour,  and  promises  to  be  extremely  useful  to 
the  graduates  and  undergraduates  of  the 
school. 


M.  Paul  Bert,  the  eminent  physiologist, 
whose  accession  to  the  office  of  Minister  of 
Public  Instruction  and  Fine  Arts  in  the  French 
Cabinet  we  lately  chronicled,  has  been  succeeded 
in  that  portfolio  by  M.  Jules  Ferry. 


Sir  Robert  Christian,  Bart.,  M.D  ,  one  of 
thn  grandest  figures  in  the  history  of  Scottish 
Medicine,  and  the  dearest  link  between  the  pre- 
sent and  the  past  of  Edinburgh  University,  has 
gone  over  to  the  majority,  full  of  honours  as  of 
years.  He  was  one  of  twins,  born  in  Edin- 
burgh, on  the  18th  July,  1797;  received  his 
general  education  at  the  High  School  and 
University,  and  graduated  in  Medicine  in  1819. 
He  early  manifested  a  fondness  for  Chemistry, 
and  after  graduation  in  Edinburgh  and  spend- 
ing several  months  at  St.  Bartholomew's  Hos- 
pital in  London,  he  went  to  Paris,  where 
he  engaged  in  laboratory  work  under  Robiquet 
and  attended  the  courses  of  Vauquelin  and 
Thenard  in  Chemistry,  and  of  Orfila  in  Toxi- 
cology. "While  in  Paris  the  death  of  Gregory 
created  certain  changes  in  the  Chairs  in  Edin- 
burgh, and  that  of  Medical  Jurisprudence 
becoming  vacant,  he  was,  although  absent, 
elected  to  fill  it.  From  this  time  he  became 
recognized  as  the  medical-jurist  of  Scotland,  and 
was  engaged  in  every  important  case  of  medico- 
legal interest,  the  first  being  the  celebrated 
one  of  Burke  and  Hare,  In  1832  he  was 
elected  to  the  Chair  of  Materia  Medica,  which 
he  occupied  up  to  the  time  of  his  resignation 
in  1877,  having  been  Professor  in  the  Univer- 
sity for  five  years  more  than  half  a  century. 
He  was  the  Nestor  of  the  Profession,  and  after 
the  deaths  of  Abercrombie  and  Alison  univer- 
sally regarded  as  its  leader  in  the  North.  His 
chief  works  were  a  "Treatise  on  Poisons" 
(1829)  and  his  "Dispensatory"  (1845).  He 
was  Crown  Member  of  the  Medical  Council 
for  Scotland,  Member  of  the  Edinburgh  Uni- 
versity Court,  and  Assessor,  Physician-in- 
Ordinary  to  the  Queen  in  Scotland,  twice 
President  of  the  Royal  College  of  Physicians, 
President  of  the  British  Medical  Association 
in  187''),  of  the  Royal  Society  of  Scotland 
after  Brewster's  death,  and  in  1876  he  was 
selected  as  President  of  the  British  Associa- 
tion for  the  Advancement  of  Science. 

We  are  pleased  to  note  that  our  fellow- 
townsman,  Dr.  R.  A.  Reeve,  Surgeon  to  the 
Andrew  Mercer  Eye  and  Ear  Infirmary,  has 
been  elected  a  member  of  the  Ophthalmologica] 
Society  of  Great  Britain. 


10'2 


CANADIAN  JOURNAL 


Physicians  their  own  Photographers. — 
Medical  men  very  frequently  want  photo- 
grap'is  in  cases  of  injury,  deformities,  &c.,  but 
the  trouble  and  expense  have  been  serious  bars 
to  obtaining  them  ;  and  many  |>atient8,  too,  can- 
not go  to  the  photographer.  Drawings  are 
often  even  more  expensive,  and  always  labour 
under  the  disadvantage  of  possible  inexactness. 
Recently,  howevei",  the  introduction  of  the  "dry 
plate"  process  has  so  simplified  the  method, 
avoided  the  former  dangers,  and  reduced  the  ex- 
pense, that  any  one  of  ordinary  intelligence  and 
means  can  now  take  all  the  photographs  he 
wants  at  a  moment's  notice.  At  the  Cincin- 
nati meeting  of  the  American  Association  for 
the  Advancement  of  Science,  last  August,  Mr. 
"Walker,  of  Rochester,  N.Y,, showed  a  "pocket 
camera,"  which,  according  to  Prof.  Lattimore, 
supplies  every  want  of  the  inexperienced  ama- 
teur. Its  weight  is  only  two  pounds.  "  Dry- 
plate  outfits  "  are  now  to  be  had  at  a  cost  of 
$10  and  upwards  which  are  excellent.  Pro- 
vided with  one  of  these  instruments,  the  doctor 
would  always  be  prepared  to  photograph  any 
case  he  desires,  at  his  office  or  in  the  sick  room. 
Our  hospitals,  especially,  should  be  provided 
with  such  a  good  outfit,  so  that  cases  and  speci- 
mens could  be  photographed  at  any  time,  even 
by  a  resident.  Our  microscopists  would  also 
find  it  exceedingly  useful  to  make  permanent 
many  a  transient  preparation  not  suitable  for 
preservation. — Medical  News. 


A  Little  Recognized  Cause  op  Delayed 
Repair  and  Convalescence  in  Wounds  and 
Diseases.  M.  A.  Ponect,  of  Lyons,  who,  by 
the  way,  has  just  been  elected  to  the  chair  of 
operative  medicine  in  the  Lyon's  Faculty  of 
Medicine,  contributes  to  the  Li/on  Medical  for 
5th  Feb.,  the  history  of  a  number  of  cascs  in 
which  indulgence  in  the  venereal  act  was  fol- 
lowed by  untoward  results  and  in  several  cases 
death.  The  cases  narrated  compi-ise  amputa- 
tions, dissection  wounds,  scalp  wounds,  whitlow 
and  fractures,  and  the  results  and  complications 
fairly  attributable  to  premature  or  excessive 
coition  were  purulent  infection,  lymphangitis, 
ganglionic  suppuration,  chronic  tetanus,  in- 
flammation of  wound,  suppuration,  delayed 
anion,  and  relapse.     The  mode  of  action  is  sup- 


posed to  be  interference  with  the  processes  of 
repair  by  nervous  shock  and  induced  debility  ; 
and  the  moral  of  the  paper  seems  to  be 
"  Mieux  vaudrait  souvent  pour  quelques  blesset 
etre  privi  de  soins  assidits  que  d'avoir  une  mat- 
tresss  pour  garde-malade. 


A  Medical  Tribunal. — We  {London  Lancet) 
commend  to  the  consideration  of  the  Govern- 
ment a  suggestion  made  in  our  loading  columns 
last  week — namely,  the  establishment  of  a 
medical  tribunal.  It  would  not  be  difficult  to 
select  from  the  ranks  of  the  medical  profession 
an  expert  physiological  chemist,  a  pathologist, 
an  experienced  clinical  physician  and  a  surgeon 
— four  in  all — three  forming  a  quorum,  as  the 
case  to  be  investigated  happened  to  be  medical 
or  surgical.  This  tribunal  might  be  required 
to  investigate  and  determine  such  cases  of  a 
purely  scientific  nature  as  were  referred  to  it 
by  the  Judges,  either  in  the  course  of  a  trial  or 
afterwards,  as  in  the  case  of  law  points  reserved 
or  sent  up  to  the  Justices  for  special  considera- 
tion. It  would  be  easy  to  construct  such  a 
tribunal,  and  the  expense  of  maintaining  it 
need  not  be  very  considerable.  It  is  necessary 
in  the  interests  of  justice  and  public  prudence 
that  a  step  of  this  nature  should  be  taken. 
Recent  events  have  made  the  decisions  of 
courts  of  law  usurping  the  authority  to  ad- 
judicate issues  of  science  obviously  and,  there- 
fore, mischievously,  ridiculous. 


Epistaxis. — Dr.  Geo.  M.  Lefferts,  Professor 
of  Laryngoscopy  and  diseases  of  the  throat  in 
the  College  of  Physicians  and  Surgeons  of  New 
York,  in  a  resent  paper  on  this  subject  in  the 
Medical  News,  affirms  that  frequently  recur- 
ring attacks  of  epistaxis,  especially  in  children, 
are  in  the  vast  majority  of  cases  due  to  a  small 
erosion  of  the  mucous  membrane  of  the  car- 
tilaginous septum,  just  above  the  point  of  the 
former's  junction  with  the  skin.  This  is  due 
to  the  violent  removal  of  a  little  inspissated 
mucus  which  has  lodged  at  that  point,  and 
is  kept  up  by  frequent  rei)etition  of  the  pro- 
cess. To  effect  a  cure  the  habit  of  picking 
must  be  avoided  and  the  erosion  kept  con- 
stantly covered  by  a  layer  of  vaseline  or 
otherwise  treated  according  to  special  indica- 
tions on  general  principles. 


OF  MEDICAL  SCIENCE. 


1P3 


EXAMINATIONS    OF    ONTARIO    MED- 
ICAL COUNCIL. 

The  professional  final  written  examinations 
will  commence  April  4th,  in  Toronto  and 
Kingston  ;  final  oral,  April  Ilth,  at  Kingston, 
and  April  13th  at  Toronto. 

The   primary  examinations   will   commence 

April  14th   at  Kingston,  and   April  18th   at 

Toronto. 

For  further  particulars  see  advertisement. 
i  «■»  ■ 

Provincial  Health  Bill. — Very  elaborate 
preparations  have  been  made  in  Montreal  to 
secure  the  introduction  into  the  Quebec  Legis- 
lature of  a  satisfactory  and  efficient  Health  Bill. 
The  Hon.  Mr.  Loranger,  Attorney-General  of 
the  Province,  has  promised  if  the  provisions 
of  the  draft  prove  satisfactory,  to  introduce 
it  as  a  Government  measure.  A  Board  of 
Health  is  to  be  organised  composed  of  certain 
members  of  the  Ministry  ex-officio^  medical 
men  of  experience  and  standing,  and  lay  mem- 
bers selected  by  the  Lieut.-  Governor-in-Council. 
The  Province  of  Ontario  may  well  blush  to  be 
thus  distanced  in  the  path  of  progress  by  her 

poorer  sister. 

«^»^« 

Medical  Dinner,  Bishop's  College. — The 

Medical  Departnoent  of  Bishop's  College,  Mon- 
treal, held  its  first  annual  dinner,  on  the  even- 
ing of  the  7th  of  December  last  in  the  Windsor 
Hotel.  There  were  about  eighty  in  attendance 
and  an  enjoyable  evening  was  spent. 

M#>-< 

PERSONAL. 

Sir  James  Paget  has  entirely  recovered  and 
returned  to  practice. 

The  death  of  Prof.  Theodor  Schwann  is 
announced. 

Kundrat,  of  Gratz,  has  succeeded  Heschl  in 
the  Chair  of  Pathology  in  Vienna. 

Dr.  W.  R.  Sutherland  has  been  appointed 
Curator  of  the  Museum  of  the  Medical  Faculty 
of  McGill  University. 

Prof.  Leidesdorf,  of  Vienna,  the  eminent 
Psychologist,  has  received  the  Cross  of  Knight- 
hood of  the  Order  of  Francis  Josei^h. 

Prof.  Trendelenburg,  of  Rostock,  has  suc- 
ceeded Busch  as  Professor  of  Surgery  at  Bonn, 
Konig,  of  Gottingen,  having  declined  the  ofier. 

Prof.    Pirogofif    died   of    epithelial    cancer, 


which  perforated  the  hard  palate.  By  his  will, 
he  has  left  500,000  silver  roubles  (£75,000). 

Prof.  Panum,  of  Copenhagen,  has  been 
chosen  President  of  the  next  International 
Medical  Congress,  and  Dr.  Carl  Lange,  Gen- 
eral Secretary. 

Dr.  George  W.  Campbell,  Dean  of  Medical 
Faculty  of  McGill  University,  has,  by  the 
death  of  his  brother  in  Scotland,  become  heir 
to  an  old  baronetcy. 

Dr.  Joseph  Workman,  Fr.  Daniel  Clark,  and 
Prof.  Wm.  Osier,  were  elected  Honorary  Mem. 
bers  of  the  Toronto  School  of  Medicine  Medical 
Society,  February  24th. 

Dr.  Orton,  of  Fergus,  was  tendered  a  public 
dinner  on  the  Uth  February  by  his  numerous 
friends  in  that  section  of  country  on  the  eve  of 
his  departure  for  Winnipeg.  The  doctor  has 
been  a  resident  of  Fergus  for  over  twenty  years ; 
and  the  success  of  the  banquet  was  a  very 
pleasing  evidence  of  the  esteem  in  which  he 
was  held. 


Fourth  Annual  Report  of  the  Fresbt/terian 
Eye  and  Far  Charity  Hospital,  77  Fast  Balti- 
more Street,  Baltimore,  Md.,  1882.  By  Julian 
J.  Chisholm.,  M.D.,  Surgeon  in  charge. 

Chronic  Club  Foot — Treated,  vnthout  Te- 
notomy,  by  Continuous  Extension  and  Stretch- 
ing. By  James  S.  Green,  M.D.  (Reprint 
from  N.  Y.  M&L  Journal  and  Obstet.  Review.) 


A  New  System  of  Surgical  Mechanics.  By 
Charles  F.  Stillman,  M.D.,  of  New  York. 
(Reprint  from  Trans.  Am.  Med.  Association.) 
Philadelphia  :  Collins,  705  Jayne  Street. 


An  Aid  to  tJia  Mechanical  Treatment  of 
Weak  Ankles  and  Inverted  Feet.  By  Charles 
F.  Stillman,  M.D.,  of  New  York.  (Reprint 
from  Medical  Record.) 

Catalogue  of  Medical,  Dental,  Pharmaceuti- 
cal and  Scientific  Publications.  Published  by 
P.  Blakiston,  Son  «fe  Co.,  1012  Walnut  Street, 
Philadelphia. 

Preliminary  Observations  on  the  Pathology  of 
Sea  Sickness.  By  J.  A.  Irwin,  M.A.,  Cantab., 
M.D.,  Dub.  (Reprint  from  The  Lancet.) 
Philadelphia  :  P.  Blakiston,  Son  &  Co. 


104 


CANADIAN  JOURNAL 


Soluble  Compressed  Pellets.  A  new  form  of 
Remedies  for  Hyjxxiermic  use,  and  applicable 
to  Ophthalmic  and  General  Medication.  By 
H.  Augustus  Wilson,  M.D.  (Reprint  from 
Trans.  Am.  Med.  Association.) 

Transactions  of  the  American  Ophthalmo- 
logical  Society — \lth  Annual  Meeting,  Newport, 
1881.  Copies  can  be  piocured  of  the  Secre- 
tary, Richard  H.  Derby,  M.D.,  at  9  West  35th 
Street,  New  York. 


The  Trance  State  in  Inebriety:  Its  Medi- 
colegal Relations.  By  T.  D.  Crothers,  M.D., 
Superintendent  Walnut  Lodge,  Hartford, 
Conn.  With  an  introduction  on  the  nature 
and  character  of  the  Trance  State.  By  Geo. 
M.  Beard,  M.D.,  New  York  City. 


Memoranda  of  Physiology.  By  Henry  AsHBr, 
M.D.  (Lond.),  Lecturer  on  Physiology,  Owen's 
College,  Manchester.  New  York  :  William 
Wood  &  Co. 

This  is  the  third  edition  of  this  little  cram 
book,  prepared  especially  for  the  use  of  students. 
It  has  become  quite  popular  in  England,  as 
shown  by  the  fact  of  the  necessity  of  a  third 
edition  within  three  years.  We  prefer  to  see 
students  write  their  own  memoranda.  Those 
unwilling  to  do  so  may  find  this  work  useful, 
but  we  cannot  recommend  it. 

A  Manual  of  Organic  Materia  Medica.  By 
John  M.  Maisch,  Phar.  D.,  Professor  of 
Materia  Medica  and  Botany,  Philadelphia 
College  of  Pharmacy.  Philadelphia  :  Henry 
C.  Lea's  Son  &  Co. 

This  book,  which  is  intended  especially  for 
pharmacists  and  druggists,  gives  a  very  brief 
but  accurate  description  of  the  physical,  histolo- 
gical, and  chemical  characters  of  organic  drugs, 
the  classification  being  based  on  their  resem- 
blance to  each  other  in  physical  and  structural 
properties,  without  any  regard  to  their  physio- 
logical actions.  A  valuable  feature  connected 
with  the  book  is  the  large  number  (194)  of 
excellent  illustrations,  both  gross  and  micro- 
scopic. We  feel  sure  that  the  work  will  be 
very  acceptable  to  those  for  whom  it  is  in- 
bended. 


Illustrations  of  Dissections  in  a  Series  of  Or- 
iginal Coloured  Plates,  Representing  tJie 
Dissection  of  the  Human  Body.  By  Geo. 
ViNER  Ellis,  Professor  of  Anatomy  in  the 
Univei-sity  College,  London,  and  G.  H, 
Ford,  Esq.  Vol.  I.  Second  edition.  New 
York  :  Wm.  Wood  &  Co.,  27  Great  Jones 
Street,  1882. 

This  is  the  January  number  of  Wood's  Li- 
brary for  1882.  The  drawings  are  from  nature, 
by  Mr.  Ford,  from  dissections  by  Professor  Ellis; 
and  the  volume  contains  "  a  concise  description 
of  a  series  of  anatomical  plates  with  some 
remarks  on  the  pra)tical  a(iplications  of  ana- 
tomical facts  to  surgery."  Of  the  original 
plates  it  is  unnecessary  to  speak  since  during 
the  last  six  years  the  excellence  of  their  execu- 
tion has  been  oft  attested,  and  Prof.  Ellis' 
authority  as  an  anatomist  is  paramount.  Of 
their  reproduction  here  we  can  only  say  that 
the  letter-press  is,  of  course,  unaltered,  and  the 
plates  themselves  (somewhat  reduced)  as  good 
and  faithful  copies  as  could  be  expected.  The 
dissections  of  the  upper  limb,  12  plates,  and  of 
the  head  and  neck,  16  plates,  are  included  in 
this  volume.  They  cannot  fail  to  be  of  service 
to  the  dissecting  student,  and  to  the  operating 
surgeon. 

A  System  of  Surgery,  T'heoretical  and  Practical, 
in  Treatises  by  various  authors.     Edited  by 
.    T.  Holmes,  M.A.,  Cantab.,  Surgeon  and  Lec- 
turer on  Surgery  at  St;.  George's  Hospital. 
First  American,from  Second  English  Edition, 
thoroughly  revised  and  much  enlirged.     By 
John  H.  Packard,  M.D.,  Surgeon  to  the 
Episcopal  and  St.  Joseph's  Hospitals,  Phil- 
adelphia ;  assisted   by   a  large  corps  of  the 
most  eminent  American  surgeons.     In  three 
volumes,  with  many  illustrations.     Vol.  II. 
Philadelphia  :    Henry  C.    Lea's  Son  &  Co., 
1881.     Toronto  :  Hart  &  Co. 
Of  this  edition  of  Holmes'  system  of  surgery 
we  have  already  spoken  in  the  highest  terms 
we  could  command  when  noticing  the  appear- 
ance of  the  first  volume,  and  repetition  of  that 
commendation  would  be  superfluous.     Vol.  II. 
contains  the  diseases  of  the  organs  of  Special 
Sense,  Diseases  of  Circulatory  System,  Diseases 
of  Digestive  Tract,  and  diseases  of  the  Genito- 
urinary  organs.       Its   publication  is  a   great 
boon  to  American  surgeons,  and  especially  to 
the  younger  generation  of  them,  none  of  whom 
can  afford  to  be  without  it.     The  onlv  article 


OF  MEDICAL  SCIENCE. 


105 


wholly  American  is  an  excellent  one  by  Busey, 
on  Injuries  and  Diseases  of  the  Absorbent 
System  ;  but  the  American  editors  have  made 
this  publication,  as  a  whole,  as  much  better 
than  the  English  original,  as  Lea's  half  Russia 
binding  and  beautiful  typography  is  superior 
to  the  old  English  cloth  edition. 


Essentials  of  the  Principles  and  Practice  of 
Medicine.  By  Henry  Hartshorn,  A.M., 
M.D.,  Professor  of  Hygiene  and  Digea.ses  of 
Children,  Women's  Medical  College  of  Penn- 
sylvania. Editor  of  the  American  Edition 
of  Reynold's  System  of  Medicine.  Phila- 
delphia :  Henry  C.  Lea's,  Son  &  Co.  Toronto: 
Hart  &  Co. 

This  is  pre-eminently  a  mvXtum  in  parvo, 
and  belongs  to  a  class  of  works  which  we  dis- 
like, but  which  continues  to  be  published 
notwithstanding  our  urgent  remonstrances. 
"  Hartshorn's  Essentials,"  is,  however,  a  very 
popular  book,  with  both  students  and  members 
of  the  profession,  and  we  must  acknowledge  that 
it  would  be  a  very  difficult  matter  to  give  so 
much  practical  and  scientific  information  re- 
specting the  broad  subject  of  medicine  within 
a  small  space  in  a  more  pleasant  and  useful 
style  than  is  presented  to  us  in  this  book.  This 
is  the  fifth  edition,  the  fourth  having  been 
published  in  1874,  and  is  quite  up  to  the 
times  in  every  particular.  We  have  in  the  600 
pages  a  fair  amount  of  general  pathology, 
general  principles,  general  therapeutics,  and 
when  we  come  to  what  our  author  calls  special 
pathology  and  practice,  nothing  appears  to  be 
omitted.  As  a  brief  and  concise  compend  of 
the  principles  and  practice  of  Medicine  we 
know  not  its  equal,  and  we  have  no  doubt  it 
will  be  highly  appreciated  by  a  fair  proportion 
of  both  students  and  active  practitioners. 


4  Text  Book  on  Physiology.  By  M.  Foster, 
M.A.,  M.D.,  F.R.S.,  Prelector  in  Physiology 
and  Fellow  of  Trinity  College,  Cambridge. 
Second  American  Edition  from  the  third 
and  revised  English  Edition.  Philadelphia  : 
Henry  C.  Lea's  Son  &  Co.  Toronto  :  Hart 
&Co. 

As  our  readers  will  probably  remember  the 
first  American  Edition  was  published  in  1880 
from  the  third  English  Edition.  This  was  ex- 
havisted  in  the  short  space  ot  one  year,  princi- 


pally through  its  sale  in  the  United  State8_ 
Although  it  has  not  been  adopted  in  Canadian 
Schools  so  generally  as  we  would  like,  still  we 
are  pleased  to  notice  that  increased  interest  is 
being  taken  in  the  work,  and  we  hope  soon  to 
see  it  in  the  hands  of  all  our  students  who  have 
any  ambition  to  gain  a  good  knowledge  of 
scientific  physiology.  This  second  American 
Edition  is  from  the  same  English  Edition  as 
the  first,  and  the  additions  and  changes  made 
by  the  American  Editor  are  so  trifling  as  to  be 
unworthy  of  special  mention.  No  new  plates 
have  been  added,  but  a  few  have  been  changed, 
and,  we  are  glad  say,  much  improved.  In  our 
somewhat  extended  review  of  the  first  edition  it 
was  our  pleasure  to  express  a  very  favourable 
opinion,  and  since  then  we  have  certainly  not 
changed  our  views.  If  we  could  add  anything 
to  impress  on  our  readers  the  high  character  of 
the  work,  we  would  gladly  do  so ;  but  will 
simply  say  without  any  reservation,  that  we 
believe  it  to  be  the  best  text-book  on  physiology 
in  existence  for  the  general  use  of  advanced 
students  and  practitioners. 

HURON  MEDICAL  ASSOCIATION. 

The  Annual  Meeting  of  the  Huron  Medical 
Association  was  held  in  Clinton,  on  Tuesday, 
January  10th.  Dr.  Sloan,  of  Blyth,  President, 
in  the  chair.  The  following  members  were 
present :  Drs.  Sloan,  Holmes,  Worthington 
Hyndman,  Williams,  Bethune,  Graham,  Young, 
Taylor,  Mackid,  Duncan,  Hurlburt,  and 
Stewart. 

Dr.  W.  J.  R.  Holmes,  of  Brussels,  was 
elected  President  for  the  ensuing  year,  and  Dr. 
Hurlburt,  Vice-President.  Dr.  Stewart  was 
re  elected.  Secretary. 

The  Association  decided  to  subscribe  for  one 
copy  of  the  "  Index  Medicus." 

Dr.  Mackid,  of  Lucknow,  exhibited  a  mar- 
ried man,  aged  43,  farmer,  who  has  been  com- 
plaining for  the  last  3  years  of  severe  pains  in 
various  parts  of  his  body,  principally  on  the 
left  side.  I  hese  pains  are  continuous  for 
hours.  He  also  complains  of  paind  of  a 
**  lightning-like "    character    confined    to    the 


109 


CANADIAN  JOURNAL 


upper  extieuiities  piincipally.  lie  Kays  his 
sight  is  dim,  and  often  after  severe  exertion  he 
is  blind  and  sees  things  double.  His  eyelids 
twitch  when  he  has  undergone  exertion.  He 
has  lost  all  sexual  desire.  He  is  seldom  able 
to  retain  his  urine  over  an  hour.  The  bowels 
are  irregular.  He  says  he  cannot  walk  well 
in  the  dark,  but  there  is  no  evidence  of  ataxia 
when  his  eyes  are  shut.     Tendon  reflex  normal. 

Dr.  Duncan,  of  Seaforth,  showed  a  very 
well-marked  example  of  Jacksonian  Epilepsy. 
The  patient  is  a  boy  4^  years  of  age,  a  twin, 
born  at  7  months.  The  premature  birth  was 
owing  to  an  injury  the  mother  received  from 
being  thrown  out  of  a  sleigh.  General  health 
good.  Had  whooping  cough.  There  has  been 
a  purulent  discharge  from  the  right  ear  ever 
since  the  child  was  two  months  old.  When 
the  child  was  nine  months  old  the  mother 
noticed  that  while  nursing  it  would  suddenly, 
and  without  apparent  cause,  stretch  itself  back 
and  leave  the  breast  for  a  short  time.  From 
the  ninth  to  the  twelfth  month  the  child  had 
very  frequently  attacks  of  ordinary  convul- 
sions. These  attacks,  however,  have  com- 
pletely passed  away.  The  boy  is  larger  and 
better  developed  than  his  twin  brother.  His 
mind  is  bright  and  active.  His  speech  is  not 
very  distinct  however. 

The  first  unilateral  convulsion  occurred  in 
June,  1878.  They  have  recurred  frequently 
since  that  time,  sometimes  there  will  be  as 
many  as  seven  in  one  day.  The  individual 
fits  occur  as  follows  :  The  first  thing  noticed  is 
generally  that  the  child  is  in  unusually  high 
spirits.  He  is  restless  and  excited,  and  talks 
strangely.  About  twenty  minutes  before  the 
convulsive  movement  begins  he  loses  the  power 
of  the  whole  left  side.  The  convulsions  com- 
mence sometimes  in  the  fingers,  sometimes  in 
the  toes,  always  on  the  left  extremity  however. 
If  they  commence  in  the  fingers  they  travel 
up  the  arm  and  down  the  leg.  If  in  the  leg, 
then  up  this  limb  and  down  the  arm.  The 
convulsive  movements  last  for  a  short  time ; 
they  are  followed  by  a  short  pause,  again 
repeated,  and  so  on  for  four  or  five  hours. 
The  tongue  is  protruded  to  the  left  side,  and 
the  eyes  are  turned  in  the  same  direction 
during  the  convulsions.     The  left  side  of  the 


face  and  forehead  get  dark  in  color  during  the 
tit.  After  the  convulsions  have  ceased  the 
child  falls  into  a  deep  sleep  from  which  he 
awakens  with  completely  paralyzed  left  ex- 
tremities. This  paralysis  passes  away  in  from 
twelve  to  twenty-four  hours.  Consciousness 
does  not  appear  to  be  completely  lost  dux'ing 
the  attacks.  Bromide  of  potassium  has  ap- 
peared to  have  prevented  many  convulsions 
which  otherwise  would  have  occun-ed.  The 
above  case  difiers  from  reported  cases  in  the 
fact  of  paralysis  preceding  as  well  as  following 
the  convulsions. 

Dr.  Taylor,  of  Goderich,  showed  the  follow- 
ing cases  : 

(1)  Pseudo-hypertrophic  muscular  paralysis. 
This  patient  is  a  boy,  aged  16,  with  a  good 

family  and  personal  history,  and  who  presents 
the  characteristic  symptoms  of  this  disease  in 
a  pronounced  degree.  His  mother  states  that 
ho  always  had  a  difficulty  in  walking,  and  was 
constantly  falling  if  travelling  over  uneven 
gi'ound.  His  playmates  styled  him  "  Stiff 
Legs."  The  calves  are  three  inches  greater  in 
circumference  than  the  upper  part  of  the 
thigh.  The  arms  are  an  inch  larger  than  the 
forearms.  There  is  general  muscular  weak- 
ness.    Patellar  tendon  reflex  is  absent. 

(2)  Left  hemiplegia  from  destruction  of  a 
portion  of  the  right  cortical  region  of  the 
brain — Epilepsy. 

The  patient,  a  female,  aged  23,  when  5  years 
of  age  sustained  a  fracture  of  the  right  side  of 
the  skull  by  a  branch  of  a  tree  falling  on  her. 
There  was  loss  of  cerebral  substance  at  the 
time.  Her  left  arm  and  leg  have  been  par- 
tially paralyzed  since.  There  is  almost  com- 
plete paralysis  of  the  arm,  but  she  has  some 
use  of  the  leg. 

The  patellar  reflex  of  the  paralyzed  limb  is 
greatly  exaggerated.  The  left  arm  is  atrophied 
and  contracted.  There  is  loss  of  bone  to  the 
extent  of  about  l^  inches  over  the  right  side 
of  the  skull,  principally  -n  the  region  known 
as  the  lower  autero-parietal  area,  and  which 
corresponds  to  the  convolutions  bordering  the 
fissure  of  Rolando. 

Three  years  ago  this  patient  had  her  first 
epileptic  fit.  Since  then  the  epileptic  convul- 
sions have  recurred  two  or  three  times  weekly. 


OF  MEDICAL  SCIENCE. 


107 


\Vi\ile  under  observation  she  had  a  fit.  The 
coavuls  01S8  which  were  general  were  of  a 
tonic  character  for  about  half  a  uaiuute,  this 
was  followed  by  three  or  four  general  clonic 
convulsions.  The  contracture  of  the  paralyzed 
arm  (lett)  was  relaxed,  and  the  eyes  were 
turned  strongly  to  the  left  during  the  fit. 
There  is  no  aura  preceding  any  of  her  fits. 
The  least  mental  excitement  is  said  to  bring 
on  a  pxroxysra.  It  was  noticed  that  immedi- 
ately preceding  the  fit  one  of  the  members  of 
the  Association  was  pressing  strongly  over  the 
right  side  of  the  skull  where  there  is  loss  of  bon''. 

(3)  A  case  of  Necrosis  of  the  Mastoid  portion 
of  the  Temporal  bone. 

This  patient  was  a  b  jy,  seven  years  of  age. 
About  four  years  ago  he  had  a  purulent  dis- 
charge from  his  I'ight  ear,  which  was  followed 
by  swelling  behind  the  ear.  A  free  incision 
was  made  into  this  swelling,  and  a  few  pieces 
of  dead  bone  removed.  The  wound  healed  up 
quickly  and  remained  so  until  a  few  months 
ago.  At  piesent  there  is  a  copious  discharge 
both  from  the  ear  and  from  the  mastoid  bone. 
The  mastoid  disease  is  supposed  to  have  been 
caused  by  a  plug  of  cotton  wool  which  had  re- 
mained in  the  ear  for  a  period  of  fifteen  mouths. 

Dr.  Worthington,  of  Clinton,  showed  a  case 
of  Paraplegia,  being  probably  an  example  of 
the  so-called  "  hysterical  paraplegia." 

The  patient  is  a  married  woman  32  years  of 
age.  Slie  has  four  children.  During  her  first 
pregnancy,  eleven  years  ago,  she  says  she  was 
unable  to  walk,  and  for  a  period  of  nine 
months  following  it  she  maintains  that  she  had 
lost  motion  and  sensation  of  the  lower  extremi- 
ties. She  recovered  completely,  and  remained 
well  up  to  her  second  pregnancy  when  she 
complained  of  "  lightnirg-like  pains "  in  her 
lower  extremities.  For  a  period  of  nine 
months  following  her  secoud  pregnancy  she 
lost  the  use  of,  and  feeling  in,  her  lower  ex- 
tremities. After  her  third  pregnancy  she 
remained  well.  Two  months  after  her  fourth 
pregnancy  (November,  1879)  she  "caught  a 
cold"  which  was  followed  shortly  afterwards 
by  loss  of  power  in  the  lower  extremities,  and 
from  this  state  she  has  not  yet  recovered. 

Present  State. — There  is  a  considerable 
loss  of  power  in  both  lower  limbs.  It  is  with 
the  greatest  difficulty  that  she  can  move  about 
when  supported  by  two  persons.  Unassisted 
locomotion  is  not  possible.  Sensation  is  ex- 
alted in  the  paralyzed  parts.  The  legs  are 
ujderaatous.  She  has  lost  power  over  both 
rectal  and  vesical  sphincters.  The  patellar 
reflex  in  both  limbs  is  greatly  exaggerated. 
Ankle  clonus  present.  She  complains  of 
})ains  darting  around  the  chest  and  abdomen. 
Vision  good.  There  is  no  spinal  tenderness  or 
unevenuess  of  the  spinous  processes. 


Dr.  Sloan,  of  Blyth,  showed  a  case  of  Ansemia 
in  a  young  man  23  years  of  age.  Eighteen 
months  ago  this  patient  hid  jaundice  lasting 
five  days.  Four  months  ago  he  commenced  to 
lose  flesh  and  color.  There  is  no  enlargement 
of  the  liver,  spleen,  or  any  of  the  lymphatic 
glands.  Blood  is  normal  in  every  respect. 
Pulse  only  38  when  lying,  sitting  45.  There 
are  no  changes  to  bo  detected  in  either  tlie 
thoracic  or  abdominal  viscera.  There  is  no 
increase  of  temperature.  The  administration 
of  iron  has  not  been  of  any  benefit. 

Dr.  HyrtdnT^n,  of  Exeter,  showed  a  very  well- 
marked  example  of  Aneurism  of  the  left  femoral 
artery  situated  at  the  apex  of  Scarpa's  triangle 

The  patient  is  a  man  23  years  of  age,  with  a 
good  family  and  personal  history. 

Three  years  ago  he  was  accidentally  shot, 
the  ball  (from  a  large  pistol)  passed  into  the 
left  thigh  about  the  centre  of  its  intenial  sur- 
face, taking  a  course,  apparently  undtr  the 
skin  and  fascia,  outwards  to  the  external 
surface  of  the  thigh  where  it  still  lies  imbe<lded 
under  the  skin.  Although  there  was  no 
extei'nal  haemorrhage  the  amount  of  shock  was 
very  great.  The  wound  healed  in  a  week,  and 
it  was  then  noticed  that  there  was  abnormal 
pulsation  about  the  apex  of  Scarpa's  triangle. 
Since  this  period  he  has  been  constantly 
attending  to  his  duties  as  a  clerk  in  a  dry 
goods  store.  At  present  there  is  a  large  ex- 
pansile pulsating  tumour  occupying  the  apex 
of  Scarpa's  triangle.  It  has  a  long  diameter 
of  four  inches  and  a  short  one  (transverse)  of 
about  2|  inches.  There  is  a  distinct  bruit  to  be 
heard,  and  a  thrill  to  be  felt  over  the  tumour. 
Pressure  on  the  femoral  artery  above  arrests  all 
pulsation  in  the  swelling.  There  is  no  oedema 
and  but  little  pain  in  the  afiected  limb. 

Drs.  Stewart  and  Hurlburt  showed  a  boy, 
aged  three,  who  has  lost  in  a  great  measure 
the  co-ordinating  power  of  the  muscles  of  his 
lower  extremities,  and  in  a  slighter  degree 
those  of  the  upper  extremities  also.  He  18 
unable  to  walk  unless  assisted.  He  walks 
much  worse  in  the  dark  or  with  his  eyes  shut. 
There  is  no  loss  of  muscular  power.  The 
patellar  tendon  reflex  is  absent  in  both  legs. 
The  general  health  has  not  sufiered  any.  The 
trouble  came  on  gradually.  It  is  now  about 
two  months  old.  Vision  is  good.  He  has  com- 
plete control  over  both  bladder  ind  rectum. 
He  has  had  an  offensive  purulent  discharge 
from  the  right  ear  for  a  year. 

Dr.  W.  J.  R.  Holmes,  of  Brussels,  showed 
a  man,  aged  fifty,  who  has  Paralysis  of  both 
median  and  radial  nerves  in  the  hands.  Full 
notes  of  this  case  will  bo  given  later. 

Dr.  Graham,  of  Brussels,  showed  a  specimin 
under  the  microscope  of  the  blood  from  a  case 
of  Pernicious  Ansemia. 


m 


CANADIAN  JOTTRNAL  OF  MEDICAL  SCIENCE. 


^U^c(Umeou$. 


REPORT  OF  THE  COMMITTEE  ON 

REVISION  OF  THE  CODE  OF 

ETHICS. 

The  New  York  State  Medical  Society  was 
called  to  order  at  8  p.m.,  and  the  following 
report  of  the  Committee  on  the  Revision  ot 
the  Code  of  Ethics  was  made  the  special 
order  of  business  : — 

!• THE   RELATIONS    OF    PHYSICIANS  TO  THE 

PUBLIC. 

It  is  derogatory  to  the  dignity  and  interests 
of  the  profession  for  physicians  to  resort  to 
public  advertisements,  private  cards,  or  hand 
bills,  inviting  the  attention  of  individuals 
affected  with  particular  diseases,  publicly 
offering  advice  and  medicine  to  the  poor 
without  charge,  or  promising  radical  cures; 
or  to  publish  cases  or  operations  in  the  daily 
prints,  or  to  suffer  such  publications  to  be 
made ;  or,  through  the  medium  of  reporters  or 
interviewers,  or  otherwise,  to  permit  their 
opinions  on  medical  and  surgical  questions  to 
appear  in  the  newspapers ;  to  invite  laymen  to 
be  present  at  operations ;  to  boast  of  cures  and 
remedies;  to  adduce  certificates  of  skill  and 
success,  or  to  perform  other  similar  acts. 

It  is  equally  derogatory  to  professional 
character,  and  opposed  to  the  interests  of  the 
profession,  for  a  physician  to  hold  a  patent  for 
any  surgical  instrument  or  medicine,  or  to 
prescribe  a  secret  nostrum,  whether  the  in- 
vention or  discovery  or  exclusive  property  of 
himself  or  of  others. 

It  is  also  reprehensible  for  physicians  to  give 
certificates  attesting  the  efficacy  of  patented 
medical  or  surgical  appliances,  or  of  patented, 
copyrighted,  or  secret  medicines,  or  of  proprie- 
tary drugs,  medicines,  wines,  mineral  watei-s, 
health  resorts,  etc. 

II. — RULES  GOVERNING  CONSULTATIONS. 

Members  of  the  Medical  Society  of  the  State 
of  New  York,  and  of  the  medical  societies  in 
affiliation  therewith,  may  meet  in  consultation 
legally  qualified  practitioners  of  medicine. 
Emergencies  may  occur  in  which  all  restrictions 
should,  in  the  judgment  of  the  practitioner, 
yield  to  the  demands  of  humanity. 

To  promote  the  interests  of  the  medical 
profession  and  of  the  sick,  the  following  rules 
should  be  observed  in  conducting  consultations. 

The  examination  of  the  patient  by  the  con- 
sulting physician  should  be  made  in  the  presence 
of  the  attending  physician,  and  during  such 
examination  no  discussion  should  take  place, 
nor  any  remark  as  to  diagnosis  or  treatment  be 
made.     When  the  examination  is  completed, 


the  physicians  should  retire  to  a  room  by  them- 
selves, and  after  a  statement  by  the  attending 
physician  of  the  history  of  the  case  and  of  his 
views  of  its  diagnosis  and  treatment,  each  of 
the  consulting  physicians,  beginning  with  the 
youngest,  should  deliver  his  opinion.  If  they 
arrive  at  an  agreement,  it  will  be  the  duty  of 
the  attending  physician  to  announce  the  result 
to  the  patient,  or  to  some  responsible  member 
ot  the  family,  and  to  carry  out  the  plan  of 
treatment  agreed  upon. 

If  in  the  consultation  there  is  found  to  be  an 
essential  difference  of  opinion  as  to  diagnosis  or 
treatment,  the  case  should  be  presented  to  the 
patient,  or  some  responsible  member  of  the 
family,  as  plainly  and  intelligently  as  possible, 
to  make  such  choice  and  pursue  such  course  as 
may  be  thought  best. 

In  case  of  acute,  dangerous,  or  obscure  illness, 
the  consulting  physician  should  continue  his 
visits  at  such  intervals  as  may  be  deemed 
necessary  by  the  patient  or  his  friends,  by  him, 
or  by  the  attending  physician. 

The  utmost  punctuality  should  be  observed 
in  the  visits  of  physicians  when  they  are  to 
hold  consultations ;  but,  as  professional  engage- 
ments may  interfere  or  delay  one  of  the  parties 
the  physician  who  first  arrives  should  wait  for 
his  associates  a  reasonable  period,  after  which 
the  consultation  should  be  considered  as  post- 
poned to  a  new  appointment.  If  it  be  the 
attending  physician  who  is  present,  he  will,  of 
course,  see  the  patient  and  prescribe ;  but  if  it 
be  the  consulting  physician,  he  should  retire, 
except  in  an  emergency,  or  when  he  has  been 
called  from  a  considerable  distance,  in  which 
latter  case  he  may  examine  the  patient,  and 
give  his  opinion  in  writing  and  under  seal,  to 
be  delivered  to  his  associate.  —  ^ew  York 
Medical  Record. 


\\v\H,  Pafnagi^is,  mH  ^uiH, 


BIRTHS. 

On  the  13th  inst.,  at  93  Brock  Street,  the  wife  of 
Dr.  E.  W.  Spragge,  of  a  daughter. 

At  Bracebridge,  on  February  14th,  the  wife  of 
W,  F.  Shaw,  M.D.,  of  a  son,  still-born. 

MARRIAGES. 

At  the  residence  of  the  bride's  father,  on  the  evening 
of  the  7th  inst.,  by  the  Rev.  J.  P.  Calder,  Dr.  J.  D. 
Cameron,  of  Iron  Mountain  City,  Mich.,  to  Kate, 
second  daughter  of  E.  McRae,  Esq.,  of  Lancaster,  Ont. 

On  Thursday,  February  16th,  at  Christ  church, 
New  York,  by  the  Rev.  Dr.  Shipman,  Dr.  James  B. 
Hunter,  to  Kate,  daughter  of  R.  G.  McPherson,  of 
Frederick,  Md. 

DEATHS. 

At  his  residence,  134  Bathurst  street,  on  Feb.  Ist, 
Dr.  J.  P.  Lynn,  of  this  city,  aged  42  years. 

At  Bracebridge,  Ont.,  on  Friday,  February  17th, 
Mary  Eveline  Nicol  Ritchie,  beloved  wife  of  Wm.  F. 
Shaw,  M.D.,  aged  24  years. 


THE 


Canadian  |0urnal  of  P^ebical  Science. 

A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 

U.  OGDEN.  M.D.,  I  ConsuUing  Editors.     I         A.  H.  WRIGHT,  B.A..  M.B.,  M.R.C.S.,  Eng.,  >^^,^^„ 

R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond., '  *  I         1.  H.  CAMERON,  M.B.,  ^^a^iort. 


8UB8CRIPTI01V,    S3    PER   AlVIVlTIfl. 


tS"  All  literary  commnnlcatlons  and  Exchanges  should  be  addressed  to  Dr.  CAMERON,  28  Qerrard  St.  East; 

or,  Dr.  WRIGHT,  312  Jarvis  St. 
tsr  All  business  communications  and  remittances  should  be  addressed  to   HART  ft  COMPAKY,  Publishers, 
■  31  and  33  King  Street,  Toronto. 


TORONTO.  APRIL,  1882. 


#fi(|ittal  (!l!0mmunif»ti0ttisi. 


AN  UNUSUAL  CASE  OF  INTESTINAL 
OBSTRUCTION. 

BY  L.  M.  SWEETNAM,  M.D.,  CM. 

The  following  case  occurred  in  the  practice 
of  Dr.  G.  B.  Smith,  of  this  city,  temporarily 
out  of  town,  who  kindly  asked  me  to  see  the 
case  with  him,  and  these  notes  are  an  almost 
verbatim  copy  of  those  written  by  him  as  the 
case  progressed. 

January  25.  Mrs.  B.,  aged  32,  was  born  in 
Ireland,  and  married  ten  years  ago.  Although 
never  robust  she  has  always  enjoyed  reasonably 
good  health.  Two  years  ago  she  had  a  mis- 
carriage, losing  so  much  blood  as  to  endanger 
her  life  ;  thinks  she  never  completely  regained 
her  strength  after  this  attack.  Her  mother  is 
alive  (aged  68)  ;  her  father  died  early.  About 
two  weeks  ago  she  moved  into  the  house  in 
which  she  is  now  living,  may  have  over 
exerted  herself  while  moving ;  when  in  the 
house  but  a  few  days  the  cellar  became  flooded 
and  remains  so. 

On  Monday  last  the  23rd  inst.,  she  was  in 
her  usual  health,  her  bowels  were  moved  twice 
during  the  day,  after  the  last  motion  she 
passed  about  four  drachms  of  blood,  and  com- 
plained of  pain  in  the  bowels,  especially  in  the 
epigastric  region. 

On  Tuesday,  Jan.  24th,  Opiates  were  ordered 
to  relieve  the  pain,  hot  applications  to  the 
abdomen,  and  a  dose  of  castor  oil. 

On  Jan.  25,  Dr.  S.  saw  her  with  Dr.  McC, 
the  pain  was  still  confined  to  the  epigastric 
region,  stomach  irritable,  milk  and  lime  water 
ordered.     As  the  oil  taken  yesterday  failed  to 


operate,  an  enema  containing  an  ounce  of  oil 
was  ordered.  Pulse  100,  small  and  hard,  tem- 
perature normal.  Saw  her  again  in  the  even- 
ing, vomiting  had  set  in  during  the  day,  and 
the  enema  had  proved  ineffectual ;  ordered 
hydrarg.  submur,  grs.  viii.  to  be  taken  at  once. 
Pulse  more  frequent,  temperature  normal. 

Jan.  25.  Called  between  ten  and  twelve 
to-day.  Stomach  unable  to  retain  anything 
for  more  than  an  hour  or  two;  complains  of 
weakness  rather  than  of  pain.  No  motion  of 
the  bowels  yet,  pain  in  the  epigastrium  some- 
what relieved  by  mustard  poultices.  Pulse 
120,  temperature  normal,  or  a  little  below. 

Jan.  27.  Tempeirature,  98;  pulse,  126; 
stomach  more  irritable  than  ever,  and  vomited 
stercoraceous  matter.  Patient  becoming  very 
weak,  ordered  nutritious  enemata  every  four 
hours.  Gave  two  powders  of  pulv.  jalapae  co., 
grs.  xlv.  in  each.  In  the  evening  found  that  the 
pulv.  j>ilapae  co.  had  been  vomited,  and  that  ster- 
coraceous matter  had  been  frequently  ejected 
during  the  day.  Patient  cannot  retain  much 
of  the  beef  tea  injections  as  the  greater  portion 
comes  away  as  soon  as  the  support  to  the 
perineum  is  removed;  ordered  ol.  crotonis  gtt. 
ij.  in  ol.  olivse  5ij,  also  chloral  hydrate  3j  doses 
to  induce  sleep. 

Jan.  28th.  Pulse  small  and  scarcely  per- 
ceptible at  the  wrist,  temperature  97|.  The 
ol.  crotonis  given  last  evening  was  vomited  in 
fifteen  minutes,  as  was  also  the  chloral.  As 
no  food  is  being  administered  by  the  mouth 
the  stomach  is  less  troublesome,  but  the  ten- 
dency to  vomit  is  seen  even  when  the  lips  are 
moistened  with  water.  As  we  had  so  far  failed 
to  relieve  the  bowels  we  decided  to  endeavour  to 
fill  the  intestines  with  w^ter,  b^  means  of  the 


110 


CANADIAN  JOURNAL 


stomach  pump  ;  when  we  had  injected  forty- 
eight  ounces  the  pain  became  so  great  that  we 
were  compelled  to  desist.  As  soon  as  the 
pressure  which  was  being  made  upon  the 
perineum  was  removed  about  six  ounces  came 
away.  7  p.m.  Found  it  impossible  to  count 
the  radial  pulse.  Patient  complained  of  great 
pain  in  the  region  of  the  heart.  Ordered 
stimulating  enemata,  and  gave  an  injection  of 
morphia. 

Jan.  29.  Mrs.  B.  died  about  11  p.m.  yester- 
day. In  connection  with  the  family  history  I 
should  have  said  that  Mrs.  B.  lost  a  sister  five 
years  ago,  the  symptoms  in  the  two  cases  being 
almost  identical. 

Patient's  tongue  has  been  fairly  normal 
throughout,  abdomen  tympanitic,  and  urine 
scanty  but  otherwise  normal. 

Post  mortem.  With  Dr.  S.  examined  the 
thoracic  and  abdominal  viscera  ;  lungs  normal, 
a  few  old  pleuritic  adhesions,  heart  abnormally 
small,  walls  thin  and  fatty,  liver,  stomach,  and 
kidneys  healthy  ;  spleen  atrophied.  Small  in- 
testines contained  some  of  the  water  injected 
yesterday;  found  the  jejunum  and  upper  two- 
thirds  of  the  ileum  very  much  dilated,  being 
equal  in  size  with  the  normal  colon.  Four 
feet  of  the  lower  end  of  the  ileum  were  very 
much  contracted,  on-cutting  across  this  portion 
of  the  intestine  it  was  found  that  the  tip  of  the 
little  finger  was  with  difficulty  inserted,  the 
intestinal  wall  being  slightly  thickened.  The 
corresponding  portion  of  the  mesentery  was 
very  much  thickened,  principally  by  the  de- 
posit of  fat,  and  in  places  would  be  three- 
sixteenths  of  an  inch  in  thickness.  The  large 
intestine  was  normal  as  far  as  the  rectum,  the 
upper  four  inches  of  which  presented  the  same 
appearance  as  the  lower  portion  of  the  ileum, 
and  p?st  this  contraction  during  life  we  had 
found  it  impossible  to  pass  the  tube  of  the 
stomach  pump. 


VIOLA  TRICOLOR  IN  A  CASE  OF 
CHRONIC  ECZEMA. 

BY  J.  FERGUSON,  B.A.,  M.B.,  L.R.C.P.,  EdIN. 

Mr.  F.  G.  was  in  Manitoba  for  a  number  of 
years,  I  think  from  1872  till  1879.  During 
his  stay  there  be  became  a  victiln  to  a  very 


severe  attack  of  eczema  which  obstinately 
resisted  treatment.  General  and  local  means 
had  been  most  diligently  employed  for  a  period 
of  nearly  two  years  and  with  no  apparent 
improvement.  The  disease  was  mainly  seated 
on  the  face,  and  the  intense  itching  and  burn- 
ing pain  was  almost  unendurable.  There  was 
great  disfigurement.  The  skin  very  thick  and 
infiltrated,  was  deeply  fissured  in  many  ])laces. 
The  whole  condition  was  that  of  great  chronicity. 
There  had  been  formerly  a  great  deal  of  exuda- 
tion, but  latterly  a  rather  dry  and  scaly  state 
of  the  skin. 

All  other  modes  of  treatment  were  abandoned 
and  the  patient  directed  to  use  daily  an  infusion 
of  viola  tricolor,  made  by  steeping  two  drachms 
in  ten  ounces  of  warm  water.  In  a  week  a 
very  active  condition  made  its  appearance. 
The  skin  began  to  discharge  a  great  amount  of 
serum,  and  there  was  more  inflammatory  ac- 
tion. The  remedy  was  then  discontinued  for 
a  short  time,  a  mild  saline  diuretic  one  being 
substituted  in  its  place.  The  viola  tricolor  was 
again  ordered  in  much  smaller  doses,  about 
forty  grains  every  day,  infused  as  above.  This 
was  continued  for  about  six  weeks.  The  treat- 
ment began  on  the  3rd  of  January,  and  dropped 
on  the  1st  of  March.  The  general  health  has 
improved  a  good  deal  and  the  appearance  of 
the  skin  is  very  favorable.  There  is  still  a 
slight  tendency  to  scaling  on  various  parts  ; 
but  the  perspiration  is  now  pretty  free  over  the 
entire  surface  of  the  body.  I  determined  to 
rely  wholly  upon  the  viola  and  use  no  local 
applications.  Large  doses  were  at  first  given 
with  a  view  to  excite  activity  in  the  skin,  this 
having  been  accomplished,  the  remedy  was  in- 
termitted for  a  little  while  and  then  much  less 
given. 

The  patient  now  sleeps  well  and  enjoys  a 
state  of  comfort  unknown  lor  several  years. 
He  is  about  sixty  and  of  lymphatic  turn.  His 
health,  however,  had  always  been  good  up  to 
the  time  Qf  the  present  attack.  His  habits 
have  been  quite  steady  and  no  irregularities  in 
diet  could  be  assigned  for  the  outbreak. 


Victor  Theodor  JuNod,  the  well-known 
inventor  of  "  Junod's  Boot,"  and  various  cup- 
ping glasses,  is  dead,  at  the  age  of  78. 


OF  MEDICAL  SCIENCE. 


Ill 


GANGRENOUS  CELLULITIS  WITH 
SLOUGHING  OF  THE  RECTUM. 

BY  UZZIELOGDEN,  M.D., 

Lecturer  on  Midwifery  and  Diseases  of  Women,  in  the  Toronto 
School  of  Medicine. 

On  the  7th  of  January  I  was  called  to  the 
country  to  see  a  lady  suffering  from  mania,  the 
result  of  overlactation  and  menorrhagia.  She 
was  32  years  of  age,  of  delicate  nervous  tem- 
perament, the  mother  of  four  children,  the 
youngest  about  seven  months  old. 
-  The  child  had  just  been  taken  from  the 
breast.  Nourishing  digestible  food,  tonics  and 
mild  purgatives  were  recommended,  and  in 
three  or  four  days  the  mania  disappeared,  the 
appetite  returned,  and  she  became  hopeful  and 
cheerful.  The  improvement  lasted  about  four 
days,  when  she  became  feverish,  restless,  and 
weak.  She  then  passsd,  by  a  single  stool,  an 
enormous  quantity  of  very  hard  scybalous  mat- 
ter, which  was  followed  during  the  next  few 
days  by  several  very  copious  semi-solid  evacua- 
tions. 

On  the  19th  I  was  again  requested  to  see  her, 
when  her  attending  physician  presented  me 
with  ."  something  very  strange  which  she  had 
passed  from  the  bowels  "  a  few  hours  before  my 
visit.  This  proved  to  be  a  large  slough,  about 
four  or  five  inches  long,  two  inches  broad,  and 
about  a  quarter  of  an  inch  thick,  but  somewhat 
ragged  and  irregular. 

On  entering  her  chamber  she  was  found  pre- 
senting the  ordinary  symptoms  of  septicaemia, 
while  two  or  three  large  tungoid  growths  oc- 
cupied the  left  labium  and  perineum.  The 
uterus  was  normal  to  touch  and  in  its  right 
place,  and  the  anus  enlarged  as  if  the  sphincter 
were  partially  destroyed. 

On  passing  my  finger  through  the  anus,  the 
whole  pelvic  cavity  appeared  to  have  been  dis- 
sected out  as  cleanly  as  if  it  had  been  done  with 
the  knife:  nothing  was  left  ;,but  the  vagina 
uterus,  muscles,  and  ligaments,  with  the  bladder 
id  front.  I  could  pass  my  fingers  between  the 
muscles  and  ligaments  at  the  sides  of  the  pelvis 
and  trace  them  to  their  attachments.  Every 
vestige  of  the  lower  three  inches  of  the  rectum 
and  pelvic  cellular  tissue  had  disappeared  as  far 
as  my  finger  could  reach,  and  the  end  of  the 
rectum  appeared  to  hang  loosely  in  the  cavity, 


about  three  inches  from  the  anus.  As  the 
cavity  contained  a  quantity  of  horribly  ofiensive 
matter,  which  was  evidently  poisoning  the  whole 
system,  I  washed  it  out  with  carbolized  water, 
and  while  doing  so  a  large  quantity  of  half  solid 
fecal  matter  was  passed  by  the  side  of  the 
syringe. 

Directions  were  given  to  wash  out  the  cavity 
with  carbolized  water,  three  or  four  times  a 
day,  and  to  let  her  have  quinine  and  nourish- 
ment as  freely  as  she  could  take  them  ;  never- 
theless she  continued  to  sink,  and  died  in  about 
nine  days  after  my  last  visit. 

The  mania  at  my  first  visit  presented  all 
the  usual  characteristics  of  puerperal  mania, 
although  from  the  length  of  time  it  occurred 
after  confinement  it  is  called  mania  of  lactation, 
and  yielded  readily  to  treatment,  although  at 
the  time  of  my  first  visit  she  was  very  weak  and 
restless,  and  very  anxious  to  have  her  old 
medical  attendant  hung. 

With  regard  to  the  extensive  sloughing 
which  took  place,  I  think  the  large  accumula- 
tion of  hard  fecal  matter  pressing  upon  tissues 
much  reduced  in  vitality,  excited  a  low  grade 
of  inflammation,  which  soon  ended  in  the  death 
of  the  parts  ajSected  ;  and  that  in  all  cases  where 
the  patient's  consciousness  is  impaired,  as  in 
mania,  we  should  ourselves  ascertain  by  actual 
examination  whether  accumulations  are  taking 
place  in  the  lower  bowel,  as  I  am  quite 
satisfied  that  nurses  and  attendants  are  often 
deceived  in  these  matters. 


CONCURRENT  MORBILI  (OR  ROTH- 
ELN)AND  VACCINIA  1 

Reported  by  Dr  L.  M.  Sweetnam. 

A.  B.,  male,  set.  25.  Never  had  any  serious 
illness.  Had  mild  scarlatina  and  parotitis 
About  seven  days  after  exposure  to  contagium 
of  measles,  pain  in  the  head  and  back  (the 
latter  only  relieved  by  recumbency),  elevated 
temperature,  increased  frequency  of  pulse,  and 
loss  of  appetite  with  general  depression 
occurred.  These  symptoms  were  persistent  for 
ten  days,  gradually  increasing  in  severity.  At 
the  end  of  this  time  a  well-marked  rigor  oc- 
curred followed  by  still  more  marked  febrile 


112 


CANADIAN  JOURNAL 


symptoms.  Three  days  after  the  occun-ence  of 
the  rigor  the  characteristic  eruption  of  measles 
appeared.  The  tentperature  on  the  evening 
previous  to  the  appearance  of  the  eruption  was 
103  three-fifths,  on  the  following  morning  104, 
and  on  the  afternoon  of  the  same  day  105 
three-fifths.  After  a  cold  sponge  bath  and  the 
administration  of  a  ten-grain  dose  of  quinine 
the  temperature  rapidly  fell,  the  thermometer 
next  morning  sinking  to  99  four-fifths. 

During  the  whole  course  of  the  disease  no 
catarrhal  symptoms  were  present,  but  a  little 
injection  of  the  conjunctival  vessels. 

The  rash  was  diff'used  over  the  whole  body 
in  three  days  and  then  gradually  disappeared 
in  three  days  more,  desquamation  ensuing  in 
the  usual  way.  A  peculiar  feature  was  a 
re-appearance  of  the  cutaneous  eruption,  three 
or  four  days  after  its  disappearance  and  whilst 
desquamation  was  still  progressing.  It  was 
especially  noticeable  if  the  patient  was  slightly 
chilled  and  sometimes  would  entirely  disappear 
only  to  return  again  under  similar  conditions. 

The  patient  was  vaccinated  with  humanized 
virus,  first  remove,  six  days  previous  to  the 
appearance  of  the  rubeolous  rash.  At  one  point 
the  vaccine  virus  being  introduced  by  minute 
scarifications  and  at  the  second  by  scraping  ofi" 
the  epidermis. 

There  was  no  evidence  of  successful  vaccina- 
tion until  the  tenth  day  after  inoculation  when 
a  small  papule  appeared  at  the  scarified  point. 
The  papule  became  a  vesicle  on  the  twelfth 
day  and  a  pustule  about  the  eighteenth,  desicca- 
tion following  in  the  usual  way,  thus  running 
a  regular  course  after  the  first  appearance  of 
the  papule. 

About  three  days  after  the  first  point  had 
reached  the  stage  of  desiccation  a  second 
papule  made  its  appearance  at  the  point  which 
had  been  denuded  of  epidermis.  This,  in  due 
course,  presented  the  characteristic  appearance 
of  a  typical  vaccine  vesicle,  being  distinctly 
umbilicated.  It  promises  to  run  through  all 
the  stages  of  a  primary  vaccination.  About  the 
beginning  of  this  stage  of  vesiculation  an  ery- 
thematous blush — looking  very  like  erysipelas 
— appeared  around  the  vesicle  and  spread  over 
the  entire  circumference  of  the  arm  and  down 
as   far  as  the  elbow.     Some  axillary  adenitis 


was  also  present.  As  there  were  some  cases 
of  erysipelas  in  the  hospital  at  the  time,  the 
patient  was  put  on  hourly  doses  of  20  minims 
each  of  Tr.  Ferri  Mur.  and  Liq.  Ammonise  Acetatis 
and  the  redness  subsided  in  twenty-tour  hours 
thereafter.  Patient's  temperature  is,  however, 
still  (19th  March)  supra-normal,  99  three-fifths. 

P.  S. — The  temperature  fell  to  normal  point 
on  23rd  March. 

The  case  is  interesting,  both  in  view  of  the 
unusual  incubating  stage,  and  as  presentiug  an 
instance  of  concurrence  of  rubeola  (or  Rotheln) 
and  vaccinia,  or  of  one  of  those  lately  reported 
in  numbers  from  the  State  of  Illinois  as  vac- 
cinia, attended  with  a  Rotheln  eruption,  and 
also  as  a  probable  instance  of  what  Dr.  Warlo- 
mont,  of  Brussels,  terms  seff  vaccinization. 
Were  it  not  for  the  presence  of  erysipelas  in 
the  building,  we  should  adopt  the  practice 
recommended  by  Warlomont,  of  re-vaccinating 
from  this  and  subsequent  vesicles,  if  any,  until 
immunity  occurred.  If  the  patient  had  measles, 
the  temperature  105  three-fifths  was  very  un- 
usually high. 

.iM»*  » 

DISLOCATION  OF  RADIUS  AND 
ULNA  FORWARDS. 

BY  WM.  CALDWELL,  M.D.,  LAKEFIELD,  ONT. 

In  completion  of  a  series  of  rare  dislocations, 
published  in  our  columns  in  the  last  few 
months,  we  are  much  pleased  to  be  able  to 
present  the  following  case  in  Dr.  Caldwell's 
practice  : — 

On  the  16th  of  May,  1878,  I  was  called  to  see 
a  little  girl,  aged  about  10  years,  daughter  of 
Mr.  H.,  residing  within  one  mile  of  this  place, 
who  had  received  an  injury  at  the  elbow  joint 
by  having  her  crutch  knocked  out  of  her  hand 
by  her  brother. 

On  examination  found  the  forearm  flexed 
on  the  arm  and  shortened  ;  in  the  situation  of 
the  olecranon  process  the  end  of  the  humerus 
was  projecting,  leaving  a  deep  depression  be- 
tween it  and  the  forearm.  I  failed  to  elicit 
any  crepitation,  and  not  knowing  at  the  time 
that  dislocation  of  the  ulna  could  take  place 
forward  without  fracture  was  quite  puzzled, 
but  determined  to  reduce  the  dislocation,  be- 
lieving if  any  fracture  existed  I  would  discover 


OF  MEDICAL  SCIENCE. 


115 


it  in  the  attempt.  While  one  of  the  friends 
held  the  arm  I  applied  extension  from  the  wrist 
with  my  left  hand  and  with  my  right  pressed 
firmly  back  on  upper  part  of  forearm,  and  soon 
the  two  distinct  thuds  of  the  dislocated  bones 
relieved  me  from  my  anxiety.  The  arm  made 
a  perfect  recovery  there  being  no  evidence  of 
any  fracture. 

She  was  somewhat  cachectic  having  suSered 
from  knee-joint  disease,  the  leg  being  anchy- 
losed  at  an  angle  of  about  45  degrees.  She 
could  not  tell  in  what  particular  way  she  fell. 


^leUf ti(Jtti8i :  lltifdiciu^. 


SUDDEN  CANITIES. 

BY  J.  FERGUSON,  B.A.,  M.B.,  L.R.C.P.  EDIN. 

(Assistant  Demonstrator  of  Anatomy,  Toronto  School  ol 
Medicine.) 

As  there  have  been  only  a  few  well-marked 
cases  of  sudden  canities  reported,  I  take  the 
liberty  of  stating  one,  which  puts  the  possibility 
of  its  occurrence  beyond  all  doubt. 

Sometime  ago  an  acquaintance  of  mine  came 
to  Toronto  to  stay  for  a  few  days  to  transact 
some  business  before  his  departure  to  Kansas, 
where  he  intended  making  his  home.  When  I 
saw  him  there  were  only  scattered  grey  hairs 
among  the  rest  which  were  very  black  and 
glossy  and  well  curled.  His  hair  was  coarse 
and  strong,  abundant  and  apparently  healthy. 

He  was  under  my  observation  for  a  period 
of  five  days.  This  efi'ected  ^a  complete  change 
from  the  above  condition  to  almost  total  grey- 
ness.  He  had  never  used  any  dressings  of  any 
kind  on  his  hair.  The  microscope  showed  a 
great  many  air  vessicles  both  in  the  medullary 
substance,  and  between  the  cortical  and  medul- 
lary substances.  The  coloring  matter  could 
be  seen  in  the  hair  filaments  as  fine  granular 
particles,  evidently  a  broken-up  condition  of 
the  diffused  state  of  pigmemtation  which  was 
still  to  be  found  in  some  hairs. 

Mr.  B.  had  met  with  a  series  of  heavy  busi- 
ness losses  and  was  much  worried.  He  stated 
that  the  window  in  the  room  he  slept  in  was 
left  up  and  that  he  felt  as  if  he  had  caught 
cold.  These  were  the  only  causes  that  could 
be  ascertained  for  the  change  in  color.  It 
should  be  mentioned  that  there  was  slight  loss 
of  cutaneous  sensibility  in  the  scalp. 


EXTRACT  FKOM  A  LECTURE  ON 
TUBERCLE, 

In  the  Course  of  Pathological  Anatomy  at  the  Middle- 
sex Hospital  Medical  School,  Janiuiry,  1882. 

BY   SIDNEY   COUPLAND,    M.D.,    F.R.C.P. 

Physician  to  and  Lecturer  on  Pathological  Anatomy  at  the 
Middlesex  Hospital. 

Gentlemen, —  Having,  in  my  last  lecture, 
given  you  as  explicit  an  account  of  the  general 
pathology  of  tubercle  as  far  as  I  understand  it, 
I  propose  to-day,  before  leaving  this  subject,  to 
recapitulate  to  you  these  facts  in  the  form  of  a 
concise  summary.  In  doing  so,  you  must  allow 
me  to  adopt  a  somewhat  aphoristic  and  dogma- 
tic method ;  for  I  feel  that  upon  this  subject, 
of  all  in  pathology,  it  is  necessary  for  us  to 
have  clear  and  definite  ideas.  There  is  hardly 
any  pathological  question  that  has  been  so 
swayed  by  every  wind  of  doctrine  as  this  of 
tubercle;  not  even  the  subject  of  inflammation 
has  been  viewed  from  so  many  standpoints, 
and  received  so  many  and  varied  explanations. 
The^conclusions  I  am  about  to  give  you  do  not 
claim  to  be  anything  else  than  the  formulated 
expression  of  ideas  gathered  from  time  to 
time  from  various  sources.  They  embody 
simply  the  essential  points  I  have  learned  from 
others,  confirmed,  so  far  as  opportunities  have 
been  given  me,  by  my  own  post-mortem  experi- 
ence. Therefore,  they  are  in  no  way  original 
or  novel.  I  hope  they  may  be  nearer  the  truth 
in  consequence ;  as  near,  that  is,  as  our  present 
knowledge  allows  us  to  go.  My  sole  aim  is  to 
teach  you  the  facts  which  are  established,  and 
the  inferences  that  appear  to  flow  from  them, 
in  the  simplest  and  plainest  manner. 

1.  Tuberculosis  is  an  infective  disease  to 
which  man  and  the  higher  animals  are  liable. 

2.  It  is  characterized  anatomically  by  the 
formation  of  minute  nodules  or  "granulations," 
composed  of  elements  like  those  met  with  in 
granulation-tissue,  the  result  of  simple  repara- 
tive inflammation. 

3.  These  nodules,  or  elementary  or  primary 
**  tubercles,"  may  occur  in  an  isolated  manner, 
or,  by  their-  confluence,  may  form  larger  or 
smaller  conglomerate  masses. 


lU 


CANADIAN  JOURNAL 


4.  The  typical  structure  of  each  fully  formeil 
primary  nodule  consists  in  (a)  a  collection  of 
lymphoid  round  cells,  enclosed  in  a  delicate 
fibrillar  meshwork  or  stroma;  (b)  in  an  intei- 
nal  zone,  more  or  less  evident,  of  larger  nucle- 
ated epithelioid  cells;  and  (c)  a  central  multi- 
nucleated or  giant  cell. 

5.  These  "tubercles"  arise  apparently  in 
connection  with  the  lymphatic  tissue  that  per- 
vades the  body.  No  region  is  exempt  from 
them.  They  may  occur  in  the  substance  of 
Organs,  in  the  bones  and  muscles,  in  serous 
membranes,  as  the  pia-archnoid,  pleura,  peri- 
cardium, and  peritoneum ;  in  synovial  mem- 
branes ;  in  mucous  membi*anes  (arising  in  the 
submucous  stratum),  as  in  the  mouth,  pharynx, 
larynx,  trachea,  bronchi,  intestines,  and  genito- 
urinary tract, 

6.  Being  ill  supplied  with  blood-vessels,  they 
can  only  attain  a  certain  size,  and  then  perish. 
The  central  cells  degenerate  first,  because  they 
are  the  farthest  removed  from  the  nutrient 
blood-stream,  and  mutual  pressure  due  to  their 
increasing  growth  hampers  their  vital  activity. 
They  become  fattily  degenerated,  soft,  opaque, 
caseous,  forming  "yellow"  tubercles,  which, 
when  isolated,  are  larger,  and  manifestly  ol 
older  formation  than  the  miliary  translucent 
grey  granules.  Where  such  tubercles  are 
confluent,  larger  and  more  irregular  caseous 
masses  are  formed.  Caseation  may  pass  into 
cretification.  On  the  other  hand,  there  is  no 
doubt  that  occasionally  the  tubercular  nodules 
take  on  a  fibroid  change,  passing  from  the 
stage  of  "granulation-tissue"  to  one  resembling 
"cicatricial  tissue". 

7.  Almost  invariably  there  occurs,  in  the 
vicinity  of  the  tubercular  formation,  some  re- 
active inflammation.  This  may  be  protective 
by  ultimately  leading  to  encapsulation  by 
fibrous  tissue  of  the  caseated  tubercular  focus; 
01*,  as  more  fi-equently  happens,  it  aids  in  the 
disintegration  of  the  surrounding  tissues,  and 
leads,  with  the  necrosis  of  the  tubercules  them- 
selves, to  destructive  ulceration. 

8.  Individuals  who  are  prone  to  the  develop- 
ment of  tubercle  are  called  "tubercular".  The 
disposition  may  be  inherited.  Probably  what 
we  recognise  as  "struma"  or  "scrofula"  is  only 
one  form  of  this  :  a  tendency  to  tuberculosis  of 


lymphatic  glands  especially  ;  just  as  in  phthisi- 
cal subjects  we  have  a  tendency  to  pulmonary 
tuberculosis, 

9.  The  tubercular  manifestation  is,  in  the 
majority  of  cases,  at  firfet  local,  i.e.,  limited  to 
one  organ  or  tissue.  It  may  remain  so  limited 
throughout  life — may  not  even  endanger  life — 
or  may  lead  to  death  by  the  local  destruction 
to  which  it  gives  rise.  On  the  other  hand,  it 
may  be  more  or  less  widely  diffused  throughout 
the  body  of  the  same  individual.  This  diffu- 
sion may  be  due  sometimes  to  the  simultaneous 
development  of  tuberculosis  in  many  parts. 
More  frequently,  it  is  due  to  a  secondary  dis- 
semination, by  a  process  of  infection, 

10.  This  dissemination  takes  place,  as  in 
cancsr,  in  two  ways  :  viz  ,  by  direct  extension, 
or  infection  of  neighbouring  tissues  by  conti- 
guity ;  and  by  general  distribution  of  the 
tubercular  virus  through  the  medium  of  the 
blood-system  (insluding  lymphatics). 

11.  The  tubercular  virus  seems  to  be  most 
potent,  or,  at  any  rate,  to  retain  its  potency, 
i.e.,  its  infective  property,  in  the  caseous  state. 

12.  Examples  of  the  local  extension  of 
tubercle,  or  of  propagation  by  contiguous  in- 
fection are  seen  :  (1)  in  the  development  of 
peritoneal  tubercle  from  intestinal  ;*  (2)  in  the 
spreading  of  tubercle  from  one  part  of  an  organ 
{e.g.  lungs)  to  another  part ;  (3)  in  extension 
from  lung  to  pleura  ;*  (4)  in  bronchial,  laryn- 
geal, and  intestinal  ulceration  excited  by  the 
passage  over  their  mucous  membratie  of  mate- 
rial expectorated  from  a  phthisical  lung;  (5) 
in  tuberculosis  of  bladder  and  vesiculse  semin- 
ales  following  upon  renal  or  testicular  tubercle, 
etc.  The  mode  of  its  local  extension  approxi- 
mates tubercle  to  the  neoplasmata,  viz.,  by  its 
elements  exciting  in  the  tissue  they  infect 
changes  leading  to  the  formation  of  cell-masses 
resembling  the  primary  focus. 

13.  The  generalisation  of  tubercle  is  shown 
in  the  disease  known  as  acute  miliary  tubercu 
losis,  which  is  characterised  by  an  eruption  of 
miliary  granulations  in  diverse  organs  and 
tissues.  Its  mode  of  occurrence  may  be  (as 
above)  compared  to  the  general  dissemination 
of  ses-ondary  cancer,  or,  perhaps  with  equal 
truth,  to  the  metastatic  suppuration  of  pyajmia. 


*Ia  these  cases,  probably  by  extenbioo  along  lymphatic  channels. 


OF  MEDICAL  SCIENCE. 


115 


With  few  exceptions,  it  appears  to  necessitate 
a  primary  tubercular  focus  to  give  rise  to  it. 
It  is  believed  that  the  infective  virus, whatever 
it  be,  enters  the  blood-stream  at  this  local 
focus,  and  is  thence  widely  disseminated,  the 
resulting  growths  being  for  the  most  part 
miliary,  grey,  and  translucent ;  life  not,  as  a 
rule,  being  prolonged  for  a  sufficient  length  of 
time  after  the  occurrence  of  the  generalisation 
to  permit  of  the  growths  becoming  confluent  or 
caseous.  As  the  membranes  of  the  brain  are 
generally  involved  in  this  widespread  infection, 
death  occurs  early. 

14.  Lastly,  tuberculosis  is  inoculible.  In 
this  respect  it  resembles  pyaemia,  and  differs 
from  the  cancers ;  for  there  is  reason  to  think 
that  it  may  be  and  is  communicated  from  one 
human  being  to  another,  e.g.,  from  husband  to 
wife,  and  vice  versd  ;  and  that  it  can  be  inocu- 
lated in  animals  from  man  (artificial  tubercle). 
There  is,  further,  a  possibility,  based  on  certain 
peculiar  morphological  resemblances  of  the 
formations,  that  bovine  tuberculosis  is  com- 
municable to  man, 

15.  If  the  foregoing  data  be  true,  it  follows 
that  tuberculosis  is  an  infective  disease,  prob- 
ably due  to  the  presence  of  a  virus,  which 
gives  rise  to  the  development  of  peculiar  tissue- 
formations,  capable  of  localised  or  general 
propagation  in  the  body,  and  characterised 
mainly  by  their  tendency  to  early  disintegra- 
tion. 

16.  Until  the  nature  of  the  virus  is  known, 
it  is  impossible  to  formulate  data  concerning 
the  conditions  under  which  the  disease  arises 
in  subjects  free  from  inherited  taint. 


ON  THE  TREATMENT  OF  SOME 
FORMS  OF  PNEUMONIA. 

BY    D.    BIDDLK,    KINGSTON-ON-THAMES. 

I  wish  to  draw  attention  to  the  remarkable 
effects  produced  by  the  perchloiide  of  iron, 
combined  with  hydrocyanic  acid,  in  cases  of 
pneumonia  of  a  low  type,  especially  those  due 
to  blood-poisoning.  Most  practitioners  will 
agree  in  having  seen  cases  of  pneumonia  run  a 
course  so  like,  in  its  general  aspect,  that  of 
erysipelas  as  to  lead  them  to  imagine  that  they 
might  be  due  to  a  similar  cause,  taking  effect 


in  the  interstitial  substance  of  the  lung,  instead 
of  in  the  subcutaneous  tissue.  I  have  seen 
many  such,  and  I  have  begun  to  apply  a  f-imilar 
treatment,  with,  as  I  say,  truly  marvellous 
effects.  The  first  case  of  the  kind  in  which  I 
ventured  on  this  treatment  was  that  of  Mrs. 
G.,  aged  35,  who  had  double  pneumonia,  with 
pleurisy  on  the  right  side,  in  February  of  last 
year.  When  I  first  saw  her,  the  pulse  was  140, 
the  temperature  in  the  axilla  103°,  and  the 
sputa  of  a  deep  rust  colour.  I  ordered  mustard 
and  linseed  poultices, and  the  following  mixture: 
R  Liquoris  ferri  perchloridi  fort.  5ij  :  acidi 
hydrocyanici  (Scheele)  m.  viij  ;  aquam  ad  3viij. 
M.  Two  tablespoonfuls  to  be  taken  every  hour, 
with  an  intervening  teaspoonful  of  brandy  in 
water.  After  thirty  hours,  the  pulse  had  fallen 
to  100,  the  temperature  to  9U°,  the  sputa  were 
entirely  devoid  of  blood,  and  the  breathing  was 
almost  normal.  This  patient  made  a  rapid  re- 
covery. 

In  the  last  case  of  the  kind  coming  under 
"my  notice,  which  occurred  last  week,  the  patient 
seemed  to  be  in  a  state  of  collapse,  or  syncope  ; 
the  pulse  of  144  ;  the  breathing  in  short  gasps; 
the  finger-ends,  as  s^en  through  the  nails,  oi 
the  colour  of  a  thunder-cloud  ;  and  both  lungs 
in  a  state  of  clog.  Delirium  also  lasted  a  whole 
night.  She  had  complained  of  shortness  ot 
breath,  and  had  a  phthisical  aspect  and  family 
history,  but  had  never  had  any  cough  until  the 
present  time.  I  ventured  upon  the  same  treat- 
ment with  her;  and  her  pulse  is  now  96,  tem- 
])erature  all  but  normal,  sputa  devoid  of  blood 
or  discolouration  of  any  kind,  and  she  herself 
anxious  to  get  up. — British  Medical  Journal. 


HYALINE  TUBERCLE. 

In  a  lecture  on  Miliary  Tubercle  given 
before  the  Vienna  Medical  Society,  Dr.  Chiari 
pointed  out  how  considerable  has  been  recent 
progress  in  the  histology  of  tubercle,  since  we 
now  recognise  as  such  not  only  that  which  con- 
sists exclusively  of  round  cells,  large  and  small, 
but  also  miliary  tubercles  which  possess  a 
strongly  develo[)ed  reticulum,  in  the  meshes  of 
which  so-called  epithelioid  cells  lie,  and  also 
varieties  with  a  distinct  fibrous  connective 
tissue.     Hence  the  histological  distinction  into 


116 


OANADIAN  JOCJRNAL 


lymphoid,  reticular,  and  fibrous  tubercles.  All 
three  forms  ordinarily  contain  some  giant  cells, 
and  all  exhibit  a  progressive  caseation  extend- 
ing from  the  centre  to  the  circumference. 
There  are,  however,  certain  exceptions  to  this 
usual  tendency  to  caseation.  Some  miliary 
tubercles  present  a  peculiar  hyaline  transforma- 
tion. This  change  was  first  observed  in  the 
miliary  tubercle  from  the  liver  of  a  child  aged 
four  yeara  and  a  half.  The  tubercles  in  the 
brain,  lungs,  and  brouehial  glands,  in  the  same 
case,  presented  the  ordinary  aspect  of  lymphoid 
tubercle.  The  clear  hyaline  aspect  of  those  in 
the  liver  gave  them  a  very  peculiar  appearance- 
It  is  believed  to  depend  on  a  hyaline  degenera" 
tion  of  the  reticulum,  and  resembles  most 
closely  the  hyaline  degeneration  of  the  capil- 
laries of  the  brain.  Dr.  Chiari  conjectures  that 
it  may  be  regarded  as  a  benign  change,  opposed 
to  the  caseation  which  tends  to  infection. — 
Lancet. 

«-♦» » 

Sanders  on  Hemorrhage  into  the 
Ventricles  of  the  Brain. — The  symptomat- 
ology of  primary,  intermediate,  or  direct 
haemorrhage  into  the  cerebral  ventricles,  hab 
been  carefully  investigated  by  Dr.  Edward 
Sanders  of  New  York,  from  an  analysis  of  the 
clinical  histories  of  ninety-four  cases  which  he 
has  diligently  collated.  The  results  of  the 
study  form  an  important  contribution  to  the 
literature  of  this  little  known  subject,  and  are 
published  in  the  October  (1881)  issue  of  the 
Amer.  Jour,  of  the  Med.  Sciences.  The  premon- 
itory symptoms,  as  indeed  those  of  onset,  do  not 
diflfer  materially,  where  the  efi"usion  takes  place 
primarily  into  the  ventricles,  from  those  of 
ordinary  cerebral  haemorrhage.  Cephalalgia  is 
the  most  common  and  constant  of  the 
premonitory  symptoms,  and  may  have  existed 
for  a  long  time  ;  dizziness  is  less  frequently 
observed.  The  attack  may  be  immediately 
fatal,  or  it  may  be  ushered  in  by  convulsions, 
by  paralysis  without  loss  of  consciousness,  by 
paralysis  with  partial  or  complete  loss  of  con- 
sciousness or  by  partial  or  complete  loss  of 
consciousness  without  paralysis :  the  latter 
being  the  most  frequent  mode  of  onset  met 
with  in  primary  intraventricular  haemorrhage, 
at  least  in  this  particular  series  of  cases.     The 


symptoms  are  elaborately  considered.  As 
regards  the  leading  phenomena  and  their 
significance,  it  is  stated  that  coma,  whether 
light  or  profound,  (is  to  be  considered  "  as  a 
constant  symptom  of  primary  intraventricular 
haemorrhage."  As  regards  motor  disturb- 
ances, no  direct  relation  can  be  traced  be- 
tween the  seat,  amount,  and  extent  of  the 
ventricular  extravasation  and  the  presence  or 
absence  of  muscular  contractures ;  and  the 
greatest  variation  is  noticed  in  different  cases  in 
the  amount,  persistence,  permanence,  or  tetanic 
characters  of  the  spasm.  Sanders  says,  in 
regard  to  general  clonic  convulsions,  that  he 
believes  them  to  be  '  one  of  the  most  important 
and  frequent  symptoms  of  immediate  ventricular 
extravasation.'  This  may  be  attributable  to 
direct  injury  from  the  effusion,  or  to  its  pressure 
upon  adjacent  motor  centres.  A  careful  com- 
parison of  simple  and  complicated  cases,  how 
ever,  shows  '  that  the  variety  and  extent  of  the 
complication  has  no  essential  bearing  in  the 
occurrence  of  convulsions,  the  ventricular 
extravasation  itself  being  undoubtedly  the  in- 
ducing cause.'  The  tdche  cerebrale  may  also  be 
present.  Where  apparent  improvement  takes 
place,  it  is  generally  soon  followed  by  symptoms 
of  the  most  aggravated  kind,  terminating  in 
death,  no  second  remission  having  been 
observed  in  a  single  case. — London  Medical 
Record. 

»  m^m  * 

NOTHNAGEL    ON   THE  PHYSICAL  EXAMINATION 

OF  THE  FiECES. — This  author  considers  the 
macroscopic  and  microscopic  examination  of  hu- 
man stools  more  important  than  the  chemical, 
and  has  carried  it  out  in  800  cases,  arriving  at 
certain  results  (Zeitsch.  fur  Klin.  Medicin., 
Band  iii),  of  which  we  give  the  following.  1. 
Small  round  scybalous  masses  are  not  necess- 
arily the  result  of  intestinal  stricture,  but  may 
be  caused  by  paralysis  of  the  peristaltic  action 
of  the  colon  allowing  their  formation  in  the 
pouches  of  the  colon.  2.  The  reaction  is 
mostly  alkaline,  but  in  infantile  diarrhoea, 
frequently  acid.  3.  The  colour  is  not  caused 
by  bile-pigment,  which  is  not  found  in  normal 
stools,  but  is  present  in  the  greenish-yellow 
stools  of  children  and  in  the  yellow  mucus 
particles   seen    in    the     stools   of  adults.     4. 


OF  MEDICAL  SCIENCE. 


117 


Various  lime-salts  are  found  microscopically  in 
the  stools,  but  none  of  clincial  importance.  5. 
Undigested  food  is  also  found  in  the  faeces. 
Starch-granules  are  rare,  even  where  the  food  is 
a  plentiful  starch-diet.  They  occur  in  larger 
quantity,  however,  in  the  stools  of  convales- 
cents from  tyhoid  fever.  Muscle-fibres  are 
commoner  than  starch-granules,  being  more 
difficult  of  digestion.  6.  Mucus  appears 
either  as  distinct  masses  or  intimately  mixed 
with  the  faeces^  and  detected  only  by  the 
microscope.  7.  Cylinder  epithelium  appears 
frequently ;  but  round  cells,  such  as  are  seen  in 
the  bronchical  section,  are  comparatively  rare. 
8.  Blood  and  the  eggs  of  intestinal  parasites 
appear  frequently,  the  blood,  although  ap- 
parently fresh,  being  almost  always  disin- 
tegrated.— James  Anderson,  M.D.,  in  Lond. 
Med.  Record. 


SCHULZ  ON  THE  PARALLELISM  IN  THE  ACTION 

OF  CoNiiN  AND  CuRARE. — This  writer  has 
been  induced  by  the  great  differences  in  speci- 
mens of  curare  and  curarin  to  experiment  with 
hydrobromate  of  coniin  as  a  substitute  (Zeitsch 
fur  Kiln.  Med.,  Band  iii).  The  effect  is  similar; 
paralysis  of  the  motor  nerve  extremities  with 
slight  muscular  contractions,  as  with  curare. 
The  heart's  action  persists  to  the  end ;  the 
nerve-centres  are  not  directly  affected  ;  and  the 
sensorium,  as  in  the  well-known  case  of 
Socrates,  remains'  clear  till  shortly  before 
death.  The  hydrobromate  is  readily  soluble  in 
water,  and  keeps  better  than  the  pure  alkaloid. 
— London  Medical  Record. 


Foot  on  Hiccough  lasting  Twenty-six 
Weeks. — In  the  Brit.  Med.  Jour.,  Dec.  1881, 
p.  983,  Dr.  A.  W.  Foot  details  the  history  of  a 
lad,  aged  15,  whom  he  was  called  to  see  after 
he  had  been  hiccoughing,  without  ceasing, 
except  during  sleep,  from  Nov.  5,  1880  to  April 
6th,  1881.  The  attack  came  on  quite  suddenly. 
He  had  previously  suffered  from  shorter  attacks 
on  two  occasions.  A  month's  treatment  with 
hemp  and  iodoform  cured  the  patient.  The 
average  rate  of  hiccoughing  was  840  per  hour, 
and  it  lasted,  without  intermission,  except 
during  sleep,  for  twenty-six  weeks. — Richard 
Neale,  M.D.,  in  Lond.  Med.  Record. 


Nicotinism. — Dr.  Allen  McLane,  Hamilton, 
in  his  work  on  nervous  diseases,  says,  that  for 
the  person  who  presents  decided  nervous  symp- 
toms, traceable  to  tobacco,  no  better  treatment 
can  be  suggested  than  the  continuous  use  of  a 
tonic  containing  iron,  quinine,  and  strychnine, 
such,  perhaps,  as  the  following  : — 

R  Strychnise  sulphatis g^-  j* 

Quinise  sulphatis 5  J* 

Tr.  Ferri  chloridi ^y, 

Acidi  phosph.  dil. 

Syr.  limonis la    5\j' 

M.  Sig. — One  teaspoonful  in  water  thrice  daily. 

Dr.  Hamilton's  prescription  for  Epilepsy  : — 
R  Strychnise  sulph gr-  !• 

Fl.  ext.  ergotae    5^. 

Sol.  potass,  arsenit. .^.   5ij. 

Sodii  bromid Jm. 

Tr.  Digitalis 5iij. 

Aquae  menth.  pip.  ad 5^v. 

M.  Sig. — A  teaspoonful  before  eating  in  a 
half  tumblerful  of  water. 

« *♦* » 

Smith  on  Chloral  in  Belladonna-Poison- 
ing.— In  the  Lancet,  Oct.  1881,  p.  589,  Dr. 
Protheroe  Smith  reports  a  case  of  belladonna- 
poisoning  from  inadvertence,  the  dose  being 
from  half  an  ounce  to  an  ounce  of  the  liniment, 
which  was  taken  at  5  a.m.  The  lady  was  seen 
at  9  A.M.,  and  a  mustard  emetic  caused  free 
vomiting.  She  was  treated  with  opium, 
stimulants,  and  food.  Next  day,  at  11  a.m., 
she  remained  still  incoherent,  restlesss  but  with 
a  fuller  pulse.  At  this  time  half  a  drachm  of 
choral-hydrate  was  given.  In  half  an  hour 
she  regained  consciousness,  and,  after  enjoying 
a  refreshing  night's  rest,  was  next  day  quite 
herself  again. — London  Medical  Record. 
«  *♦* » 
Prof.  Drasche,  of  Vienna,"  in  a  lengthy 
article  shows  that  many  cases  of  severe  neural- 
gia are  caused  by  diabetes.  These  neuralgic 
affections  are  worse  at  night,  and  are  usually 
symmetrical.  He  recommends  morphia  and 
quinine  in  large  doses,  with  cold  packs,  and 
bathing;  and  a  milk  diet  long  continued, greatly 
improved  the  condition.  The  sugar  first  began 
to  disappear  and  then  the  pains, — Wkn,  Med. 
Woch. 


118 


CANADIAN  JOUKNAL 


MWV}^, 


THE  DIAGNOSIS  OF  EPITHELIOMA 
OF  THE  TONGUE. 

BY  HENRY  T.  BUTLIN,  F.R.C.S.,  ENG. 

AssisUnt-Surgeon.and  Demonstrator  of  Surgery  and  of  Diseases 
of  the  Throat,  St.  Bartholumew'a  Hospital. 

Most  surgeons  will  admit  that,  if  operations 
for  the  removal  of  epithelioma  of  the  tongue 
are  to  be  undertaken  with  any  prospect  of  per- 
manent success,  they  should  be  performed  at 
the  earliest  possible  period  of  the  disease,  while 
yet  but  a  small  segment  of  the  tongue  is  affected 
and  the  lymphatic  glands  are  sound.  Most 
surgeons  will  agree,  therefore,  that  a  ceitain 
and  early  diagnosis  of  epithelioma  of  the  tongue 
is  exceedingly  to  be  desired.  No  means,  how- 
ever, are  described  by  which  a  certain  and 
early  diagnosis  can  be  effected.  The  characters 
which  chiefly  are  relied  on  are,  the  sinuous  out- 
line of  the  epithelial  ulcer  ;  its  raised,  everted, 
nodular  borders  ;  its  glazed,  or  foul  and  ragged 
surface,;  and  the  surrounding  induration.  But 
every  surgeon  knows  how  often  one  or  the 
other  of  these  characters  is  absent,  and  bow 
often  many  of  them  are  simulated  in  a  tuber- 
culous or  syphilitic  ulcer,  and  how  difficult  the 
diagnosis  of  certain  cases  is,  not  merely  in  their 
early  stages,  but  when  they  have  existed  many 
months.  Mr.  T.  Smith's  case,  reported  from 
the  St.  Bartholomew's  Hospital  consultations  in 
the  last  volume  of  the  Journal  (1881,  vol.  ii, 
page  1,015),  affords  an  admirable  illustration 
of  the  difficulty  of  distinguishing  between 
epithelioma  and  tertiary  syphili-s  of  the  tongue. 
It  shows,  too,  the  disastrous  result  which  fol- 
lows the  practice  of  deferring  an  operation 
until  the  eflect  of  anti-syphilitic  remedies  has 
been  observed. 

This  watching  of  malignant  ulcers,  and  study- 
ing the  effect  of  remedies  upon  them,  is  so 
common,  that  a  surgeon,  so  far  from  being 
blamed  for  following  it  until  the  disease  is  too 
far  developed  for  operation,  would  more  prob- 
ably be  blamed  for  adopting  the  opposite 
principle,  and  freely  cutting  out  a  disease  of 
doubtful  nature.  It  is  at  present  almost  im- 
possible to  make  a  certain  diagnosis  of  all  forms 
of  malignant  ulcers  in  all  parts  of  the  body ; 


but  in  the  tongue  I  believe  it  is  possible,  and 
not  extremely  difficult. 

The  structures  of  which  epithelioma  is  com- 
posed are  very  characteristic,  and  lie  so  close 
to  the  surface  that  they  can  easily  be  procured 
for  examination  by  scraping  the  surface  of  the 
ulcer  with  a  blunt  knife  or  Volkmann's  spoon, 
or  any  similar  instrument.  In  addition  to  pus, 
and  blood-corpuscles;  debris,  and  microzymes, 
numerous  epithelial  cells  are  always  present, 
but  differ  widely  from  the  normal  epithelium 
of  the  tongue.  Many  of  them  are  smaller  than 
the  normal  cells ;  others  are  much  larger  ;  the 
nuclei  of  both  kinds  are  several  times  larger 
than  the  normal  nuclei.  All  the  cells  are 
granular ;  some  of  them  are  clouded  and  opaque 
with  granular  matter.  Some  contain  large 
round  or  oval  spaces,  clear  and  well  defined. 
Many  of  them  have  more  than  a  single  nucleus, 
and  some  contain  smaller  cells  with  nuclei  and 
nucleoli.  The  shape  of  these  abnormal  cells 
varies  as  much  as  does  their  size ;  some  are 
round,  some  oval,  some  quadrangular  or  poly- 
gonal, some  tapering  at  one  end,  and  some  at 
both  ends.  With  these  distorted  and  fantastic 
cells,  normal  epithelium  may  be  mingled  ;  but 
the  normal  cells  are  few  in  number,  while  the 
diseased  cells  ai*e  many. 

Sometimes,  and  not  unfrequently,  even  more 
characteristic  structures  than  those  described 
are  found  ,  i.  e.,  cell-nests,  or  portions  of  cell- 
nests. 

I  first  applied  this  method  of  examination  in 
the  case  of  an  epithelioma  of  the  tongue  in  a 
young  man,  where  the  diagnosis  was  difficult, 
partly  on  account  of  the  patient's  age  (29). 
The  microscopic  'characters  of  a  scraping  dis- 
pelled all  doubt  of  the  nature  of  the  disease. 
I  have  since  used  it  in  several  difficult  cases 
with  the  greatest  satisfaction.  In  order  to 
prove  that  the  test  is  reliable,  I  have  made 
sections  after  removal  of  the  epitheliomata 
which  have  been  scraped  and  examined  before 
removal,  and  have  thus  been  sure  that  the 
diagnosis  was  correct.  I  have  also,  examined 
scrapings  taken  from  other  kinds  of  ulcers  of 
the  tongue,  and  have  never  found  structures 
resembling  those  of  epithelioma.  Pus,  and 
blood,  and  granulation-corpuscles  are  present 
in  large  quantities.     Micrococcus-masses,  debris, 


OF  MEDICAL  SCIENCE. 


119 


and  normal  epithelium  are  almost  always  pre- 
sent j  but  diseased  and  altered  epithelial  cells 
are  not  found. 

I  can,  therefore,  confidently  slate  that  the 
structures  I  have  described  are  found  in  epithe- 
lial carcinoma  of  the  tongue,  and  they  are  not 
found  in  any  other  kind  of  ulcer  with  which  I  am 
acquainted.  I  cannot  yet  say  when  these  struc- 
tures begin  to  be  formed,  and,  therefore,  how 
soon  an  epithelioma  may  be  recognised  by  ex- 
amining a  scraping  from  it.  But  I  know  that 
they  are  early  formed  :  for  I  have  found  them 
in  ulcers  of  only  a  few  weeks'  duration,  which 
few  persons  would  have  ventured  certainly  to 
diagnose  and  treat  as  cancerous,  had  it  not  been 
for  their  presence. 

I  do  not,  of  course,  allege  that  this  proposi- 
t;on,  thus  to  examine  malignant  ulcers,  is 
original ;  but  I  desire  to  place  it  on  a  firmer 
footing  than  hitherto  ;  to  show  how  far  it  is 
reliable,  and  in  what  cases  it  should  be  used. 

The  method  is  very  simple,  and  very  easily 
applied.  The  surface  of  the  nicer  to  be  ex- 
amined is  cleaned  by  lightly  brushing  it,  or 
gently  scraping  it  with  a  blunt  instrument ;  a 
slightly  deeper  scraping  is  then  taken,  mixed 
with  a  drop  of  water  on  a  glass  slide,  and  ex- 
amined with  a  quarter-inch  power,  or  No.  7  Hart- 
nack.  The  pain  produced  by  this  operation  is 
so  trivial  that  it  seldom  calls  forth  a  complaint; 
and  the  scraping  may  be  repeated  several  times, 
if  necessary,  without  seriously  inconveniencing 
the  patient.  It  may  be  employed,  not  only  for 
epithelioma  of  the  tongue,  but  for  squamous 
epithelioma  (squamous-celled  carcinoma),  when- 
ever it  occurs  in  accessible  situations.  I  have 
used  it  for  epithelioma  of  the  upper  jaw,  the 
face,  the  penis,  and  the  uterus.  I  am  afraid 
it  cannot  be  employed,  however,  for  malignant 
ulcers  other  than  squamous  epitheliomata  with 
any  degree  of  certainty  ;  for  the  structures  of 
which  most  of  them  are  composed  are  not  suffi- 
ciently characteristic  to  be  easily  recognised. 

One  caution  may  be  given.  It  must  not  be 
too  hastily  assumed  that  an  ulcer  is  not  epithe- 
liomatous  because  these  structures  are  not  at 
once  discovered.  If  its  general  characters  be 
suspicious,  it  should  be  repeatedly  examined 
before  a  definite  conclusion  is  arrived  at. 

I  hope  it  will  not  be  believed,  because  I  re- 


commend so  strongly  this  method  of  diagnosis, 
that  I  am  insensible  to  the  general  characters 
of  epithelial  ulcers,  or  that  I  desire  others  to 
take  no  notice  of  them.  On  the  contrary,  I 
think  they  should  be  as  carefully  studied  in  the 
future  as  in  the  past ;  and,  when  any  of  them 
can  be  shown  to  be  reliable  in  diagnosis,  the 
microscope  should  be  dispensed  with. — British 
Medical  Journal. 


NERVE-STRETCHING. 

The  rapid  spread  among  neurologists  and 
surgeons  of  the  operation  of  nerve-stretching 
illustrates  alike  the  barrenness  of  our  thera- 
peutics and  the  zeal  of  the  profession.  It  is 
thirteen  years  since  Billroth,  unexpectedly  to 
himself,  cured  a  case  of  reflex  epilepsy  by 
stretching  the  sciatic  nerve.  Three  years 
later,  in  1872,  Nussbaum  reported  a  case  in 
which  he  had  cured  a  spastic  paralysis  of  the 
arm  by  stretching  the  lower  cervical  nerves. 
Nevertheless,  as  late  as  1877,  when  Vogt  first 
published  his  monograph  upon  nerve-stretch- 
ing, he  could  collect  only  ten  reported  cases. 
In  these  cases  nerve-stretching  had  been  done 
chieflv  for  painful  or  spasmodic  troubles. 

The  popularity  of  the  operation  became  first 
established  in  1879,  when  Langenbuch  pub- 
lished his  case  of  nerve-stretching  for  loco- 
motor ataxia.  In  so  hopeless  and  painful  a 
disease  as  this  almost  any  remedial  measure 
which  offered  any  promise  would  be  eagerly 
adopted.  Langenbuch  found  many  imitators, 
and  the  operation  soon  became  widely  known. 

Dr.  Carl  Gussenbauer,  reviewing  its  history 
in  the  Prager  Medicinische  Wochenschrift,  states 
that  already  about  two  hundred  cases  of 
nerve-stretching  for  various  diseases  have  been 
reported. 

The  application  of  nerve-stretching  has  now 
been  widely  extended  in  its  application  to  dis- 
ease. Neuralgias  of  the  fifth  cranial  nerve, 
intercostal  neuralgia,  sciatica,  and  traumatic 
neuralgias  of  the  arm  have  been  treated  by 
this  method ;  also  epilepsies  and  paralysis 
agitans,  spasms,  contractures,  and  ansesthesiaa, 
whether  of  central  or  peripheral  origin.  Cen- 
tral diseases,  such  as  myelo-raeningitis,  trans- 
verse    myelitis,     lateral     sclerosis,     multiple 


120 


CANADIAN  JOURNAL 


sclerosis,  progressive  muscular  atrophy,  athet- 
osis, etc.,  are  reported  as  having  been  more  or 
less  benefited  by  nerve-stretching.  Langen- 
buch,  who  has  operated  in  about  thirty  cases, 
reports  rapid  and  complete  cure  of  a  case  of 
chronic  pemphigus,  and  also  of  senile  pruritus, 
by  this  new  procedure.  De  Wecker,  of  Paris, 
has  even  devised  an  operation  for  stretching 
the  optic  nerve,  and  it  seems  as  though  the 
Burgeon  would  soon  have  his  hands  on  every 
nerve  in  the  body. 

Of  the  absolute  therapeutical  value  of  the 
procedure  it  is  impossible  to  speak  positively 
as  yet,  except  that  in  ataxia  the  results  are 
discouraging.  Gussenbauer,  however,  fur- 
nishes some  facts  regarding  what  results  have 
so  far  been  accomplished.  In  nerve-stretching 
for  neuralgia — trigeminal,  intercostal,  sciatic, 
etc, — in  65  cases  there  were  38  cures  and  14 
improvements. 

In  reflex  epilepsy,  clonic  spasms,  and  pain- 
less contractures,  among  23  cases  there  were 
12  cures  and  9  improvements  reported. 

In  trismus  and  tetanus,  among  28  cases, 
only  8  were  relieved ;  the  remainder  died,  8 
with  some  previous  evidences  of  improve- 
ment. 

Many  cases  of  anaesthesia  have  been  im- 
proved. Lawrie,  of  Calcutta,  reports  30  cases 
in  which  nerve-stretching  had  been  done  to  re- 
lieve the  anaesthesia  of  leprosy.  The  results 
were  more  or  less  favourable. 

The  reasonableness  of  nerve-stretching  as  a 
therapeutical  measure  can  be  better  understood 
when  we  remember  that  it  is  simply  a  mechani- 
cal procedure,  allied  in  kind  to  nerve-pound- 
ing, massage,  powerful  electrical  currents, 
etc. 

The  nerve  is  a  ribbon  of  slight  elasticity, 
but  quite  extensible.  The  sciatic  nerve  can  be 
stretched  10  ctm.  with  a  weight  of  60  pounds 
(Vogt).  The  ulnar  nerve  can  be  stretched 
one-twenty-fifth  of  its  length,  and  it  will  then 
resume  its  original  length  if  the  stretching  is 
not  prolonged.  The  extension  of  the  nerve 
aflfects  various  parts  differently.  *It  slides  in 
its  sheath,  and  Vogt,  without  good  grounds, 
considers  this  to  be  the  chief  thing  that  hap- 
pens in  nerve-stretching.  If  stretching  is 
slight,  and  does  not  go  beyond  the  limits  of 


the  normal  elasticity  of  the  nerve-structures, 
this  sliding  may  be  all  that  happens.  But  if 
nerve-stretching  is  violent  or  prolonged,  not 
only  the  relations  of  the  sheath  and  the  elas- 
ticity of  the  tissue,  but  the  cohesion  of  the 
nervcjrtissue  itself  is  affected.  Microscopical 
examinations  of  stretched  nerves  show  that 
there  may  be  a  more  rapid  coagulability  of  the 
medullary  sheath  (Schleith),  a  separation  of 
this  sheath  from  the  neurolemma  (Valentin), 
or  a  solution  in  the  continuity  of  the  axis- 
cylinder  and  medulla,  as  a  result  of  the  vio- 
lence done. 

The  question  whether  by  stretching  the 
nerves  the  cord  can  be  appreciably  moved,  is 
not  settled.  There  is  about  an  equal  number 
of  experimenters  upholding  each  view.  Some 
of  the  evidence,  pro  and  con,  was  given  at  the 
last  meeting  of  the  Neurological  Society,  re- 
ported in  this  issue.  It  is  quite  certain,  at 
any  rate,  that  the  stretching  affects  the  cord 
in  some  way,  in  a  minority  of  cases. 

What  the  results  of  nerve-stretching  upon 
the  function  or  nutrition  of  the  cord  may  be 
is  also  doubtful.  So  far  it  seems,  as  a  rule,  to 
have  been  very  slight.  Its  effect  upon  the 
nerve-trunks,  however,  is  a  direct  and  ap- 
preciable one.  Many  experimenters  have  con- 
firmed the  fact  that  stretching  a  nerve  impairs 
or  destroys  its  irritability,  and  this  independent 
of  the  circulation.  We  know,  also,  that  it  can 
break  up  the  inflammatory  adhesions  of  a 
perineuritis,  and  can  alter  the  relations  of 
the  nerve  with  its  blood-supply. 

It  is  evident,  on  the  whole,  that  we  have  in 
nerve-stretching  an  addition  of  some  value  to 
mechanical  therapeutics. 

Furthermore,  it  seems  probable  that  the  so- 
called  subcutaneous  nerve-stretching  may,  in 
many  cases,  take  the  place  of  the  cutting  oper- 
ation. This  will  make  the  procedure  a  very 
simple  one. 

It  should  be  added  that  American  neurolo- 
gists and  surgeons  have  added  not  a  little  to 
our  knowledge  of  the  value  of  this  operation, 
as  may  be  seen  by  the  recent  paper  read  at  the 
Neurological  Society,  by  Dr.  Morton,  and  by 
a  recent  article  of  Dr.  Ashurst's  in  the  Phila- 
delphia Medical  Times. — New  York  Medical 
Record. 


OF  MEDICAL  SCIENCE. 


121 


IMPURITIES  OF  CHLOROFORM. 

M.  Regnault,  at  the  Academy  of  Medicine, 
recalled  the  discussions  relative  to  the  impuri- 
ties in  chloroform  used  for  surgical  purposes, 
and  the  accidents  which  may  supervene  in 
consequence.  He  mentioned  the  unreliability 
of  the  ordinary  permanganate  test. 

M.  Gosselin  had  long  been  of  the  opinion 
that  the  accidents  were  due  to  the  faulty 
method  of  administration,  rather  than  to  the 
impurities  of  chloroform.  His  method  of 
administration  was  to  cause  the  patient  to  take 
four  chloroform  inspirations,  then  two  inspira- 
tions of  pure  air,  then  six  of  chloroform  and 
two  of  air,  then  eight  of  chloroform  and  two 
of  air,  and  so  on,  separating  by  two  inspirations 
of  pure  air  the  lengthening  series  of  chloroform 
inspirations.  He  thought  the  accidents  were 
due  to  individual  disposition,  for  all  patients 
were  not  affected  in  the  same  manner  by  the 
same  chloroform  on  the  same  day. 

M.  Verneuil  considered  the  best,  surest, 
and  most  practical  test  for  the  impurities  of 
chloroform  was  the  sense  of  smell.  He,  like 
M.  Gosselin,  considered  the  fault  to  be  in  the 
method  of  administration  rather  than  in  the 
contained  impurities.  He  considers  the  acci- 
dents largely  due  to  personal  habits  and 
diatheses.  The  only  objection  he  had  to 
chloroform  was  that  it  produced  by  its  instant 
action  upon  the  pharynx  a  spasm  of  suffoca- 
tion— this  did  not  occur  in  patients  previously 
tracheotomized.  The  quality  of  the  chloroform 
he  considered  of  secondary  importance ;  all 
depends  upon  the  mode  of  administration. 
M.  Maurice  Perrin,  on  the  contrary,  considers 
the  minor  accidents,  such  as  inability  to  pro- 
duce anaesthesia,  vomiting,  &c.,  of  which  alone 
he  is  speaking,  to  be  due  to  the  contained  im- 
purities, and  that  they  have  nothing  to  do 
with  the  mode  of  administration.  For  thirty 
years  he  has  used  chloroform,  yet  it  is  only 
since  1878  that  he  has  noticed  it  acting  differ- 
ently ;  with  purified  specimens  he  has  obtained 
the  good  results  of  former  times  without  being 
able  to  state  precisely  in  what  these  impurities 
consist,  he  considers  himself  justified  in  attri- 
buting these  accidents  to  the  impurities  of  the 
drug. 


M.  Regnault  thought  that  even  the  purest 
chloroform  was  susceptible  of  rapid  alteration 
on  exposure  to  the  light,  and  in  contact  with  a 
fatty  body.  He  recognised  as  good  chloroform 
that  which  poured  upon  a  piece  of  paper  folded 
in  two  retained  its  agreeable  odour  until  com- 
plete evaporation.  He  thought  some  people 
had  the  chloroform  sickness  as  others  had  sea- 
sickness. 


SUCCESSFUL  REMOVAL  OF  A  TWENTY 
POUND  CYST  OF  THE  PANCREAS. 

Dr.  N.  Bozeman,  of  the  Woman's  Hospital, 
New  York,  reported  at  a  late  meeting  of  the 
N.  Y.  Pathological  Society  (Medical  Record, 
Jan.  14,  1882),  the  case  of  a  lady,  wife  of  a 
distinguished  physician  of  Texas,  who  came  to 
the  hospital  for  the  removal  of  a  supposed 
ovarian  tumor.  Such  had  been  the  diagnosis 
given  by  all  who  examined  her.  The  tumor 
had  been  growing  for  five  years.  It  was  ex- 
posed and  two  and  a  half  gallons  of  fluid  re- 
moved by  tapping.  On  passing  the  hand  into 
the  abdomen  the  operator  soon  found  that  it 
was  not  attached  to  the  ovaries  or  to  the 
uterus,  and  after  some  difficulty  traced  it  to 
the  tail  of  the  spleen,  from  which  it  was  re- 
moved by  careful  dissection.  The  pedicle  was 
about  three-fourths  of  an  inch  long,  and  the 
same  in  diameter,  and  though  it  contained 
several  large  veins,  there  was  no  haemorrhage, 
and  not  a  single  ligature  was  required.  The 
weight  of  the  fluid  and  tumor  was  twenty  and 
one-half  pounds.  Its  point  of  attachment,  says 
J  )r.  B.,  was  almost  precisely  in  the  position 
occupied  by  the  bullet  in  the  late  case  of  our 
deceased  President.  The  patient  underwent 
special  preparation  for  the  operation.  She 
took  salicin,  fifteen  grains  three  times  a  day 
for  two  weeks.  On  the  morning  of  the  day  on 
which  the  operation  was  performed  she  re- 
ceived fifteen  grains  of  quinine  with  one  of 
opium,  and  when  she  went  upon  the  table  she 
was  thoroughly  "  cinchonized."  The  patient 
rallied  from  the  anaesthetic  and  from  the  opera- 
tion without  any  shock  whatever.  After  the 
operation  she  took  by  the  rectum,  at  intervals 
of  six  hours,  ten  grains  of  quinine  with  two 
ounces  of  beef-juice,  half  a  drachm  of  liquor 


122 


CANADIAN  JOURNAL 


opii  comp.,  and  two  drachms  of  brandy.  On 
the  third  day  the  temperature  reached  its 
highest  point,  101.5°  F.,  but  the  pulse  never 
rose  above  98.  Subsequently  the  pulse  fell  to 
80,  and  the  quantity  of  quinine  was  gradually 
lessened,  but  on  the  eighth  day  after  stopping 
the  quinine  the  temperature  rose  to  102.8°  F. 
The  quinine  was  again  resumed,  ten  grains 
every  six  hours,  and  the  temperature,  in  the 
course  of  thirty-six  hours,  fell  to  99.5°  F.,  and 
subsequently  the  patient  had  progressed  in  the 
most  isatisfactoiy  manner,  and  there  was  every 
prospect  of  a  complete  recovery.  She  was  dis- 
charged cured,  January  9,  1882,  the  thirty- 
eighth  day  after  the  operation. — Pacific  Medi- 
cal and  Surgical  Journal.     ■ 


Anaesthetic  Mixtures. — The  Yienna  mix- 
ture, with  which  eight  thousand  operations 
have  been  performed  without  an  accident,  con- 
sists of  ether,  3  parts ;  chloroform,  1  part. 
Billroth's  favourite  anaesthetic  mixture  is 
chloroform,  3  parts ;  ether  1  part ;  alcohol,  1 
part.  An  English  mixture,  known  as  the  A. 
C.  E.  mixture,  consists  of  alcohol,  1  part ; 
chloroform,  2  parts ;  ether,  3  parts. 

Owing  to  the  different  volatility  and  specific 
gravity  of  the  various  anaesthetic  liquids,  the 
vapors  have,  necessarily,  a  different  compo- 
sition from  that  of  the  mixture  [^themselves. 
The  value  of  a  mixture  must,  therefore,  in 
part,  be  determined  empirically.  Some  ex- 
periments have  been  made  in  the  mixing  of 
heart-stimulants  with  chloroform.  Sanford 
mixed  one  pound  of  chloroform  with  two 
drachms  of  amylnitrite.  Others  have  added 
oil  of  turpentine  to  the  chloroform.  The  ob- 
jection 80  far  has  been  that  such  mixtures 
cause  a  headache. — N.  Y.  Medical  Record. 


Perils  of  Ether. — Professor  Briggs  (Nash- 
ville Journal  of  Medicine  and  Surgery)  had  an 
unpleasant  experience  during  the  administra- 
tion of  ether.  The  vapours  of  the  anaesthetic 
agent  were  ignited  by  the  flame  of  the  spirit- 
lamp  of  the  spray-producer.  Fortunately  no 
serious  effects  resulted,  and  the  operation  pro- 
ceeded to  a  successful  termination.  This  was 
the  first  accident  of  the  kind  that  had  ever 
occurred  at  the  Hospital  Clinic. 


Chrysophanic  Acid  Externally. — Dr.  Geo. 
Henry  Fox,  in  the  Medical  News,  recommends 
the  following  method  of  employing  chryso- 
phanic acid,  so  as  to  avoid  the  severe  derma- 
titis, and  the  spoiling  of  underclothing  and 
bed-linen  apt  to  ensue  from  its  use  : — "  A  soft 
paste  is  made  by  rubbing  the  chrysophanic 
acid  with  a  sufficient  quantity  of  water,  and 
smeared  upon  the  psoriatic  patches,  the  scales 
of  which  have  been  previously  removed  by  one 
or  more  hot  baths,  with  soap  friction.  As 
soon  as  the  paste  has  dried,  which  it  does  in 
one  or  two  minutes,  a  layer  of  collodion  should 
be  allowed  to  flow  over  each  patch,  and  to 
harden  into  a  protective  coating]"  This  will 
remain  for  several  days;  when  it  falls,  or  is 
displaced,  the  application  should  be  renewed. 

M  ♦  »  « 

Old  Standing  Luxation  of  Shoulder — 
Reduction. — M.  Pollaillon  reports  the  reduc- 
tion of  an  intra-coracoid  luxation  of  the  left 
shoulder,  of  four  months'  duration.  In  a  first 
trial,  using  a  traction  force  of  115  kilo,  for 
fifteen  minutes,  he  reduced  it  to  a  sub-coracoid. 
After  a  rest,  he  sub-cutaneously  divided  the 
fibrous  bands  which  existed  at  the  external 
part  of  the  articulation,  and  which  had  appeared 
to  be  an  obstacle  to  the  re-entrance  of  the  head 
into  its  icavity.  Afterwards  the  head  was 
easily  drawn  into  its  position,  and  the  patient 
has  recovered  all  the  motions  of  the  arm. 


Unna  on  the  Treatment  of  Cicatrices. 
— Unna  has  found  (abstract  in  Viertelj.  fur 
Derm,  und  Syph.,  Heft  2  and  3,  1881,  p.  499) 
the  cicatrices  of  smallpox,  and  after  ulceration, 
much  improved  in  appearance  by  daily  rubbing 
with  fine  sand.  A  small  sponge  soaked  with 
soap  lather,  is  dipped  in  the  powder  collected 
from  the  debris  of  marble,  and  is  then  steadily 
rubbed  over  the  cicatrix.  The  resulting  im- 
provement is  attributed  to  the  stimulating 
effect  of  the  mechanical  irritation. — London 
Med.  Record. 


Billroth  has  exhibited  arsenic  in  large  doses 
in  malignant  lymphomata.  He  gave  gtt.  v. 
Fowler's  solution  and  gradually  increased  to 
gtt.  XXX.  or  XL.,  and  only  stopped  increas- 
ing if  troublesome  intoxication 'came  on.  He 
has  in  this  way  secured  good  results,  and,  as  it 
were  watched  a  self  cure.  There  was  passing 
fever,  and  the  remedy  seemed  to  cause  diarrhoea 
and  vomiting  at  times. — Wien.  Med.  Woch. 


OF  MEDICAL  SCIENCE. 


123 


Pidwtf^rjj. 


DEATH   AFTER    OVARIOTOMY,    DUE 
TO  PRELIMINARY  TAPPING. 

BY  LAWSON  TAIT,F.R.C.S.,  BIRMINGHAM,  ENGLAND. 

In  the  last  series  of  one  hundred  operations 
which  I  have  performed  for  the  removal  of  ova- 
rian cystoma,  there  have  been  three  deaths,  and 
in  all  of  these  cases  the  patients  had  been  pre- 
viously tapped.  The  deaths  were  all  of  the  same 
kind,  and  were  due  to  the  san\^  cause — heart- 
clot  ;  and  they  would,  I  feel  sure,  most  certainly 
not  have  occurred  but  for  the  tapping.  With 
such  an  experience,  I  think  it  quite  time  that  a 
strong  opinion  was  pronounced  against  the  prac- 
tice of  tapping  ovarian  tumors  in  all  cases 
where  removal  of  the  disease  is  possible. 

I  propose  to  allude  particularly  to  only  one 
of  these  cases,  and  to  give  it  without  any  de- 
tails, such  as  might  lead  to  its  identification, 
for  I  do  not  desire  to  convey  an  impression 
that  I  blame  the  gentleman  who  performed 
the  tappings.  He  was  but  carrying  out  the 
principle  which  until  lately  governed  our 
practice  in  such  cases  :  to  palliate  and  stave 
oflf  the  major  operation  as  long  as  possible. 
Whilst  the  mortality  of  ovariotomy  with  the 
clamp  was  twenty-five  per  cent,  this  was  the 
correct  thing  to  do,  but  now  that  the  mortality 
is  only  three  or  four  per  cent.,  especially  when 
the  whole  of  that  very  small  death-rate  seems 
to  be  due  entirely  to  conditions  produced  by 
delaying  the  operation,  we  must  reverse  our 
practice  and  perform  ovariotomy  in  an  early 
stage  of  the  disease.  If  my  operations  were 
confined  to  cases  which  had  never  been  tapped, 
I  think  I  should  have  no  mortality  at  all,  or, 
at  any  rate,  less  than  one  per  cent. 

The  case  in  question  was  one  in  which  neither 
the  age  of  the  patient  nor  the  character  of  the 
tumor  were  such  as  to  warrant  an  unfavorable 
prognosis,  but  I  told  my  friend  who  sent  me 
the  case  that  she  would  probably  die  of  heart- 
clot  in  thirty  or  forty  hours  after  the  operation, 
because  she  had  been  tapped  a  great  many 
times.  On  the  day  of  operation  she  was 
of  immense  girth,  yet  sixty  pints  of  fluid 
had  been  taken  from  her  only  a  few  days 
before. 


The  fluid  was  intensely  albuminous,  that  is 
to  say,  it  was  made  viscid  by  a  large  amount 
of  one  or  more  of  those  mysterious  inconstant 
coagulable  substances  found  in  ovarian  and 
ascitic  fluid,  I  have  made  prolonged  researches 
on  the  nature  of  these  substances,  and  so  far  I 
have  found  no  two  exactly  alike,  and,  therefore, 
I  look  upon  it  as  hopeless  to  expect  that  we 
shall  ever  be  able  to  reduce  them  to  order  or  to 
a  satisfactory  nomenclature.  It  is  perfectly 
certain  that  the  abstraction  of  these  albumin- 
ous substances  in  large  quantities  deprives  the 
blood  of  some  very  important  items  of  its  con- 
stitution, and  it  is  no  less  certain  that  when 
the  blood  has  been  robbed  of  these  substances 
the  rest  of  its  constituents,  or  some  of  them, 
have  a  tendency  to  coagulate  in  a  most  unusual 
way.  The  patient  of  whose  case  I  am  speak- 
ing did  not  look  anaemic,  and  she  was  not  very 
much  emaciated,  but  within  three  years  she 
had  had  at  least  seventy  gallons  of  fluid,  with 
about  eight  per  cent,  of  solid  matter  in  it,  re- 
moved by  tapping. 

Unfortunately  the  result  of  the  operation 
fulfilled  my  prediction.  In  a  few  hours  the 
swelling  of  her  legs,  the  difficulty  in  breathing, 
the  slight  delirium,  the  rapid  rising  of  her 
pulse  and  its  speedy  disappearance  from  the 
extremities,  showed  me  that  my  previous  ex- 
periences were  being  repeated.  From  the  point 
ot  ligature  in  the  stump  a  firm,  colorless  clot 
began  to  grow.  It  gradully  occupied  the 
whole  venous  system,  finishing  its  work  in 
thirty-six  hours.  Such  an  ending  I  have 
never  seen  in  any  case  in  which  there  had 
been  no  repeated  previous  tapping.  I  con- 
clude from  this  and  from  the  fact  that  all 
the  three  deaths  in  my  last  hundred  cases  have 
been  of  "exactly  the  same  kind,  that  ovarian 
tumors  should  never  be  tapped  until  it  has 
been  ascertained  that  they  cannot  be  removed. 

If  a  patient  is  once  tapped  she  insists  on  its 
repetition,  as  long  as  she  gets  a  few  weeks' 
relief  from  it,  whereas,  if  she  had  the  tumor 
removed  in  an  early  stage,  she  would  have  per- 
manent relief  without  risk.  The  first  tapping  is, 
therefore,  the  step  that  is  to  be  avoided,  for 
not  only  is  it  risky  in  itself — far  more  risky, 
I  believe,  than  the  removal  of  an  untapped 
ovarian   tumor — but  it  complicates  the  subse- 


124 


CANADIAN  JOURNAL 


quent   operation   in   a   very   fatal  manner. — 
If.  Y.  Medical  Record. 

■  m^m.. 

Statistics  in  Thirty-two  Consecutive 
Ovariotomies. — During  the  year  1881,  Dr. 
John  Homans,  of  Boston,  has  undertaken  to 
operate  upon  ovarian  tumors  on  thirty-five 
different  occasions.  In  three  of  them  explor- 
atory incisions  were  made,  and  further  oper- 
ative procedures  abandoned.  These  patients 
all  subsequently  recovered.  Of  the  thirty- 
two  cases,  twenty-nine  recovered.  The  tumors 
varied  in  weight  from  five  to  forty-two  and 
one-half  pounds.  In  twelve,  adhesions  existed. 
Among  the  successful  operations  was  one  upon 
a  lady  seventy-three  years  of  age. — N.  Y.  Med. 

Record. 

».<♦» « 

Incontinence  of  Urine  in  Children. — Dr. 
Janeway,  in  the  N.  Y.  Medical  Record  says,  the 
combination  of  ergot,  belladonna,  and  iodide  of 
iron,  proves  more  useful  for  incontinence  of 
urine  in  children  than  either  of  the  drugs  alone, 
or  than  any  other  combination  which  has  been 
tried. 


^0m$ii0ttdetta. 


To  the  Editor  of  the  Canadian  Journal  of  Medical  Sciencb. 

OUR  MEDICAL  TARIFF  ASSAILED  BY 
A  COUNTY  COURT  JUDGE. 

GRATUITOUS    INSULT   TO    THE    PROFESSION. 

Dear  Sir, — I  send  you  a  short  history  of  a 
rather  unique  case  in  order  that  those*  who 
meet  with  similar  cases  may  benefit  by  this 
one,  and  not  allow  the  treatment  of  it  by  our 
Division  Court  Judge  to  become  a  precedent. 
The  case  is  as  follows  : — In  the  spring  of  1880, 
Dr.  Clarke,  of  this  town,  and  I  were  asked  by 
a  solicitor,  on  behalf  of  members  of  a  family, 
to  provide  them  with  a  joint  certificate  con- 
taining an  opinion  of  their  father's  competency 
to  take  charge  of  his  affairs.  We  did  so.  The 
aged  father  was,  previous  to  this  and  some  time 
afterwards,  under  my  care.  Dr.  Clarke  received 
his  fee  from  a  member  of  the  family  shortly 
after  rendering  his  services.  I  received  mine — 
six  dollars — one  dollar  for  mileage,  in  due  time 
from  the  solicitor  for  the  e8t^^te.     Nearly  three 


months  after  the  certificate  referred  to  was 
given,  another  member  of  the  family  asked  me 
if  I  could  furnish  him  with  a  certificate  such 
as  I  had  given  the  estate.  I  told  him  I  could 
not  give  him  a  copy  as  I  did  not  keep  one,  but 
that  I  could  furnish  him  with  a  similar  certifi- 
cate. He  called  afterwards  with  a  brother,  and 
asked  for  a  certificate  to  be  furnished  by  Dr. 
Clarke  and  myself  He  called  again  and  got  it. 
I  rendered  him  an  account  of  five  dollars  on 
three  separate  occasions,  after  which  he  called 
on  me  and  denied  any  responsibility  for  pay- 
ment, stating  that  he  had  been  acting  for  his 
brother,  and  asked  why  I  did  not  send  it  into 
the  estate.  I  placed  the  account  in  a  collector's 
hands,  and  he  sued  it  in  the  Division  Court  on 
March  1st.  inst..  Judge  Jones  presiding.  After 
hearing  the  facts  of  the  case,  the  Judge  did 
not  question  defendant's  responsibility  in  the 
matter,  but  remarked  that  the  services  rendered 
in  giving  the  second  certificate  were  not  equal 
to  those  of  the  first,  and  consequently  reduced 
the  account  to  three  dollars,  notwithstanding  a 
legalized  tariff  was  placed  in  his  hands  which 
permits  us  to  make  a  charge  of  from  five  to  ten 
dollars  for  the  services  rendered.  I  had  charged 
the  lowest.  The  defendant  at  no  time,  in  or 
out  of  Court,  in  my  hearing,  objected  to  the 
largeness  of  the  account.  From  the  history  of 
the  patient  recorded  in  my  note-book,  and  the 
knowledge  in  my  possession  as  his  medical 
adviser,  I  was  enabled  to  do  my  part  in  draw- 
ing up  both  certificates,  which  were  similar. 
Wherein  do  the  services  differ?  Take  it  for 
granted  the  services  were  not  the  same,  it  was 
not  for  the  Judge  to  say  what  was  a  reasonable 
charge.  That  was  settled  for  him  by  the  tariff 
placed  in  his  hands,  and  the  Ontario  Medical 
Act,  of  which  two  sections  I  transcribe : — 

XXXV.  Every  person  registered  under  the 
provision  of  this  Act  shall  be  entitled,  according 
to  his  qualification  or  qualifications,  to  practice 
medicine,  surgery,  or  midwifery,  or  any  of 
them,  as  the  case  may  be,  in  the  Province  of 
Ontario,  and  to  demand  and  recover  in  any 
Court  of  Law,  with  full  costs  of  suit,  reason- 
able charges  for  professional  aid,  advice,  and 
visits,  and  the  cost  of  any  medicine  or  other 
medical  or  surgical  appliances  rendered  or 
supplied  by  him  to  his  patients. 


OF  MEDICAL  SCIENCE. 


125 


XYI.  ThQ  said  Division  Association  may 
from  time  to  time  submit  to  the  council  a  tariflf 
or  tariffs  of  professional  fees,  suitable  to  their 
Division,  or  to  separate  portions  of  their 
Division,  and  upon  the  said  tariff  or  tarriffs  of 
fees  receiving  the  approval  of  the  Couucil, 
signified  by  the  seal  of  the  College,  and  by  the 
signature  of  the  President  thereof  being  ap- 
pended thereto,  such  tariff  or  tariffs  shall  be 
held  to  be  a  scale  of  reasonable  charges  within 
the  meaning  of  section  thirty  five  of  this  Act 
for  the  Division  or  section  of  a  Division  where 
the  member  making  the  charge  resides. 

Written  opinions  involving  a  question  of  law 
were  furnished  to  opposing  parties,  for  which 
our  tariff  allows  us  to  claim  for  each  five 
dollars  in  a  Court  of  Justice,  and  the  Judge 
has  no  alternative,  in  case  it  is  proven  that  the 
certificate  has  been  rendered  and  not  paid  for, 
but  to  give  judgment  for  the  full  amount. 
While  stating  the  case  to  the  Judge,  he  asked 
me  if  it  was  an  opposite  opinion  to  the  first 
that  I  had  given  the  second  party.  I  answered, 
"  No,  sir ;  I  could  not  do  such  a  thing,"  when 
he  remarked  that  he  (defendant)  would  have 
required  another  doctor  to  do  that.  Such  a 
question  and  such  a  remark  would  ill  become 
the  lowest  pettifogger  in  an  attempt  to  discon- 
cert a  witness  in  any  Court  of  Justice.  The 
document  furnished  the  defendant  was  pro- 
duced to  the  Judge  who,  a  moment  after  read- 
ing it,  made  the  remark  that  he  had  carefully 
read  the  certificate,  but  did  not  find  an  opinion 
that  he  had  simply  observed  some  statements 
from  which  there  had  been  no  deduction  made. 
Now,  sir,  said  certificate  read  as  follows  : — 
"  We,  the  undersigned,  hereby  certify  that  we 

examined  Mr. ,  of  the  township  of  , 

during  the  last  four  months,  and  that  we  found 
him  suffering  from  senile  dementia  to  such  an 
extent  that  he  is  wholly  incapable  of  trans- 
acting any  business  whatever — not  even  direct- 
ing his  household  affairs.  The  folio  wing  is  a  short 
account  upon  which  we  base  the  above."  Then 
follow  the  statements  to  which  the  Judge  re- 
ferred. Think,  sir,  of  a  Judge  who,  after  a  careful 
perusal  of  a  not  very  lengthy  certificate,  would 
forget  what  was  at  the  beginning.  I  may  state 
that  on  the  strength  of  our  first  certificate,  on 
the  written  opinion,  on  the  deduction,  on  the 


statement  of  facts  contained  therein,  a  guardian 
was  appointed  to  the  estate.  And  this  second 
certificate,  which  contained  the  same  opinion, 
the  same  deduction,  the  same  statement  of  facts, 
and  for  which  we  were  as  responsible  as  that  of 
the  first,  supplied  three  months  afterwards  to 
an  opposing  party,  whereby  the  information  in 
possession  of  the  solicitor  for  the  estate  might 
be  ascertained,  is  only  worth  half  that  of  the 
first  in  the  judgment  of  the  Judge.  Truly  this 
is  an  assault  upon  our  tariff  when  we  consider 
that  the  charge  in  each  case  was  the  lowest  we 
are  entitled  to.  The  decision,  I  believe,  is 
without  a  parallel.  It  would  be  a  great  rarity 
to  find  a  town  'or  country  practitioner  making 
an  overcharge.  If  they  are  enjoying  a  lucrative 
practice  it  is  due  to  overwork,  and  at  the  ex- 
pense of  their  days,  and  it  is  a  little  disconso- 
ling  to  find  a  Court  of  Justice  assaulting  our 
tariff  in  defiance  of  the  Medical  Act,  consider- 
ing the  large  amount  of  services  rendered 
gratuitously  by  the  profession  to  the  poor 
members  of  society.  I  would  like  to  ask  what 
right  has  a  County  Judge  to  reduce  our  tariff, 
and  without  any  provocation  grossly  insult 
members  of  the  medical  profession,  and  the 
profession  at  large  1  From  men  occupying  the 
position  of  County  Court  Judges  we  would  at 
least  expect  better  things,  and  it  is  to  be  hoped 
that  the  decision  of  Judge  Jones  in  this  case  is 
simply  a  malpractice  due  to  a  want  of  know- 
ledge, and  a  more  careful  perusal  of  the  Ontario 
Medical  Act. 

I  am,  sir,  yours  faithfully, 

W.  Burt. 
Paris,  March  Srd,  1882. 

»  ■»* ■ 

To  the  Editor  of  the  Canadian  Journal  or  Medical  Scibkcm. 

UNPROFESSIONAL, 

Sir, — Since  I  began  the  practice  of  medicine 
about  ten  years  ago,  it  never  fell  to  my  lot  to 
come  in  contact  with  so  gross  a  specimen  of  un- 
professional conduct  as  occurred  in  this  town 
about  three  weeks  ago,  and  to  which  the  follow- 
ing facts  will  bear  testimony  : — 

On  a  Sabbath  morning  I  was  called  to  attend 
a  young  woman,  whom  I  found  suffering  from 
circumscribed  peritonitis.  I  left  her  two  pow- 
ders composed  of  pulv.  opii.,  1^  grs.  each,  with 
a  little  bismuth,  to  be  t^eij  wjtbin  three  hours 


126 


CANADTA.N  JOURNAL 


of  each  other.     These  had  the  effect  of  remov- 
ing all  pain  ;   but,  unfortunately,  the  patient 
feeling  so  much  better,  left  the  bed,  dressed 
and  came  down  a  flight  of  stairs,  when  the  pain 
returned  with  much   greater  violence,  and  at- 
tended with  more  severe  constitutional  symp- 
toms.    I  prescribed  a  few  more  opiate  powders 
in  the  afternoon,  and  on  Monday  morning  I 
had  the  satisfaction  of  finding  my  patient  again 
free  from  pain,  temperature  falling  and  pulse 
le.ss  frequent,  which  improvement  continued  to 
progress  all  day.     On  Tuesday  morning  I  was 
confined  to  my  ted  with  congestion  of  the  lungs. 
The  mother  of  the  patient  came  to  report.    She 
told  me  her  daughter  was  free  from  pain,  and 
feeling  comfortable,  with   the  exception  of  a 
feeling  of  nausea,  which  I  informed  her  was  the 
effect  of  the  powders  she  had  taken,  and  would 
soon  pass  away.    However,  I  asked  her  to  have 
another  physician  see  her  daughter  that  day,  if 
she  thought  it  necessary,  as  I  was  unable  to 
attend.     Acting  on  this  advice  sbe  called  in  a 
doctor  of  the  town,  when  he  at  once  condemned 
my  treatment,  stating  that  he  did  not  see  the 
necessity  of  opiates,  and  that  they  were  only 
"  baking "   the  bowels  and  doing  harm.      He 
began  his  treatment  with  quinine,  brandy,  and 
purgatives,  with  a  faithful  use  of   Davidson's 
syringe  with  no  effect  so  far  as  movement  of 
the  bowels  was  concerned,  but  very  naturally 
with  this  result, — death  of  the  patient  the  next 
night  from  general  peritonitis.     I  might  men- 
tion that  hot  fomentations  and  poultices  were 
used   from   the  beginning,  and  they  were  dis- 
continued by  the  doctor's  orders.    Had  I  known 
of  the  change  of  treatment  on  Tuesday  morn- 
ing, the  patient's  life  would  have  been  spared, 
for  I  would  at  once  have  advised  a  consulta- 
tion, which,  with  a  moral  certainty,  would  have 
rescued  the  poor  girl  from  the  consequences  of 
such  cruel  and  ignorant  treatment. 

Trusting,  Mr.  Editor,  that  I  have  not  trans- 
gressed too  much  on  your  time  and  space, 
I  am,  yours  &c., 

W.  McCluee. 
Thoeold,  Mar(^  6th,  1882. 

N.B. — We  are  not  anxious  to  foster  cor- 
respondence of  this  sort,  failing  to  see  the  good 
to  be  accomplished.  The  pillory  incog,  is  not 
much  dreaded  by  the  unscrupulous,— Ed. 


To  the  Editor  of  the  Canadian  Journa     of  Medical  Sciinci. 

Sir, — I  am  glad  you  did  me  the  kindness  to 
say  regarding  this  newspaper  business  that  you 
know  me  too  well  to  believe  that  I  had  any 
knowledge  of  the  scandalous  article  that  ap- 
peared in  the  Arthur  paper.  Still,  lest  your 
kindly  word  was  said  out  of  simple  courtesy, 
and  to  remove  any  possible  misgiving  in  the 
minds  of  your  readers,  I  have  to  say  : — 

1st.  That  when  this  worthy  Francis  Morris 
was  about  to  leave  the  Hospital,  he  showed 
me  a  long  article  that  he  had  prepared  for  our 
local  papers.  Of  course  I  refused  to  allow  him 
to  have  it  inserted.  He  went  to  his  home,  a 
distance  of  about  30  miles,  in  December  last, 
and  excepting  that  he  wrote  me  a  note  a  week 
after  he  left,  I  neither  saw  him  nor  heard  from 
him  till  some  time  in  February. 

2nd.  I  never  saw  the  newspaper  mentioned, 
and  did  not  yet  see  the  article  referred  to,  only 
as  copied  by  one  of  our  local  papers,  about  the 
middle  of  last  month. 

3rd.  In  the  past  four  years  I  can  recollect 
only  one  other  instance  where  I  was  made  the 
victim  of  a  newspaper  scandal  of  a  similar 
character.  In  that  case  also,  it  was  done  en- 
tirely without  my  knowledge  or  sanction  in 
any  way. 

4th.  I  do  not  yet  think  I  was  wrong  in  call- 
ing attention  to  the  occurrence  I  alluded  to 
regarding  Dr.  Groves,  and  for  the  following 
i-eason,  though  he  may  have  been  innocent  in 
that  particular  case,  yet  it  was  only  one  of 
many.  Scarcely  a  week  passed  that  we  did 
not  see  a  paragraph  announcing  to  the  public 
that  Dr.  Groves  performed  this  or  that  opera- 
tion. But  since  the  circumstance  was  noticed 
in  the  Journal,  we  have  seen  only  one  such 
announcement  in  four  months.  If  the  Dr.  had 
given  the  patients  and  their  friends  to  under- 
stand, as  many  medical  men  have  done,  that  he 
could  not  permit  his  name  to  be  so  used,  this 
gratuitous   advertising   could   not   occur  very 

often. 

Yours  respectfully, 

Angus  McKinnon. 

1  Mt^  ■ 

Mr.  Jas.  p.  White,  the  late  eminent 
Doctor's  son,  has  donated  his  father's  valuable 
medical  library  to  the  Medical  Department  of 
the  University  of  Buffalo. 


OF  MEDICAL  SCIENCE. 


127 


THE  CANADIAN 


0»riiii(  ol  llflifiii  hum, 


A  Monthly  Joarnal  of  Medical  Science,  Criticism, 
and  News. 

To  Correspondents. —  We  shall  be  glad  to  re- 
ceive from  our  friends  everywhere,  current  meaical 
news  oj  general  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwarding  reports  of  the  proceedings  of  their 
Associations. 


TORONTO,  APRIL,  1882. 

THE  PROVINCIAL  BOARD   OF 
HEALTH. 

It  is  with  a  feeling  of  great  satisfaction  that 
we  refer  to  the  passage  of  the  "  Act,"  intro- 
duced by  Hon.  Mr,  Hardy,  "  to  establish  a 
Provincial  Board  of  Health,  and  to  give 
increased  powers  to  Local  Boards  of  Health." 
The  Act  is  similar  to  that  of  the  State 
of  Michigan,  but  with  some  changes  for  the 
better.  We  have  elsewhere  Jgiven  the  consti- 
tution of  the  Board. 

Among  the  duties  of  the  Board,  special  rel- 
erence  is  made  to  the  study  of  vital  statistics 
and  records  of  deaths  and  sickness,  of  the 
causes  of  disease  (especially  when  endemic  or 
epidemic),  nd  of  the  influences  of  various 
localities,  employments,  conditions,  habits,  etc. 
The  Board  is  also  to  make  suggestions  as  to  the 
limitation  and  prevention  of  contagious  and 
infectious  di-eases,  to  inform  the  Government 
and  Local  Boards  and,  by  various  means, 
the  people  generally,  regarding  matters  con- 
nected with  public  health  \  and  to  advise 
concerning  the  sanitary  conditions  and  ar- 
rangements of  public  buildings  and  institu- 
tions. In  the  event  of  an  outbreak  of  any 
epidemic,  the  Board  will  be  the  Central  Board 
under  cap.  190,  R.S.O. 

We  have  had  some  very  good  reports  on  the 
death-statistics  of  the  Province,  and  we  are 
pleased  to  see  that  increased  attention  is  to  be 
paid  to  the  lessons  which  may  be  drawn  there- 
from. We  are  also  glad  that  the  Provincial 
Secretary  has  referred  to  "  records  of  sickness," 


and  we  would  indulge  the  hope  that  before  long 
provision  will  be  made  for  the  collection  cf 
such  records.  Much  misery,  and  loss  of 
strength,  and  energy,  and  time,  and  money 
may  exist  without  greatly  influencing  the  death 
rate,  and  it  is  highly  desirable  that  we  should 
know  the  causes  and  be  able,  if  possible,  to 
furnish  means  of  rectifying  them.  Take,  for 
instance,  one  common  example  : — Intermittent 
Fever — not  one  of  the  worst,  but  one  commonly 
knownand  better  understood  than  some  others: — 
How  little  the  death-rate  would  tell  us  about 
it ;  and  yet  how  much  may  be  done  by  sanitary 
reform  in  preventing  its  occurrence!  It  is  also 
very  undesirable  to  have  to  wait  in  any  class  of 
cases  till  the  death-rate  warns  us  of  the 
mischief  that  has  been  abroad,  and  which 
might,  to  better  purpose,  have  been  learned 
earlier  from  the  "records  of  sickness."  The 
labours  of  Mr.  Monk  will  have  left  fresh  in  the 
minds  of  many  of  our  readers  the  details  of 
his  scheme  of  disease-registration  and  the 
arguments  in  its  favour.  The  advantages  to  be 
derived  from  the  other  duties  assigned  to  the 
Board,  in  the  above  enumeration,  are  too  self- 
apparent  to  need  any  remarks  from  us. 

To  the  Local  Boards  of  Health  are  given  in- 
creased powers  in  regard  to  infectious  diseases  : 
they  may,  at  any  time,  establish  hospitals  for 
the  reception  of  persons  afilicted  with  "  in- 
fectious diseases  dangerous  to  the  public  health ;" 
and  if  the  disease  has  actually  broken  out  they 
must  do  so.  Full  powers  are  given  for  the 
removal  or  isolation  of  persons  so  afflicted. 
We  must  call  the  attention  of  our  fellow- 
practitioners  to  the  fact  that  under  the  new 
law  they  are  required  to  give  notice  to  the 
Local  Board,  (to  the  clerk  ol  the  municipality 
if  no  special  Health  Board  exists)  when  called 
to  see  any  such  cases.  Rules  may  be  laid 
down  and  enforced  for  disinfection  of  clothing, 
etc.,  in  connection  with  hospitals,  but  they  are 
not  made  applicable  to  patients  not  sent  to 
Hospitals.  Nor  is  there  any  penalty  attached 
to  infected  persons  entering  public  conveyances 
or  buildings.  We  think  it  is  a  crying  evil  that 
persons  may  carry  about  the  scales  of  scarlet 
fever,  and  other  infectious  matter,  and  dissem- 
inate them  broad-cast.  Store-keepers  j  ust  cut 
of  bed  from  scarlet  fever,   for  example,    may 


128 


CANADIAN  JOURNAL 


send  the  infection  out  to  their  customers,  and 
in  numerous  like  ways  disease  is  spread  without 
let  or  hindrance. 

"We  have  no  doubt  the  Board  will  take  cog- 
nizance of  this  and  other  matters  to  which  we 
might  refer  in  connection  with  the  Act,  and 
we  believe  the  Provincial  Secretary  and  the 
Go«fernment  are  anxious  that  all  that  is  practic- 
able and  reasonable  shall  be  done  for  the  preser- 
vation of  health. 

We  have  heard  it  objected  that  the  Act  will 
be  inoperative,  inasmuch  as  the  compulsory 
powers  are  so  small,  and  that  it  should  be  more 
like  the  English  Act;  but  we  must  remember 
cest  le  premier  pas  qui  coute,  and  we  hope  that 
much  that  is  desirable  will  follow.  It  is  neces- 
sary to  enlist  the  sympathies  of  the  people  indi- 
vidually, and,  as  represented  by  their  municipal 
bodies,  and  the  condition  of  things  here  and  in 
England  is  very  different  in  many  respects. 

It  will  be  one  of  the  first  duties  of  the  Board 
and  its  Secretary  to  arouse  the  bodies  mentioned 
to  the  consideration  of  the  importance  of 
preventitive  medicine,  and  to  show  what  a 
profitable  investment  money  spent  in]  that 
direction  will  be. 

The  profession  has  long  been  agitating  for 
the  formation  of  a  Provincial  Board;  this  has, 
at  length,  been  attained,  and  all  that  is  now 
necessary  to  remove  from  our  fair  Province  the 
stigma  of  being  behind  some  of  her  neighbours 
in  this  path  of  civilization — a  due  attention 
to  sanitary  matters — is,  that  the  members 
of  the  profession,  one  and  all,  should  do  what 
they  can  to  aid  the  Board,  both  by  making  sug- 
gestions to  it,  and  by  helping  and  even  antici- 
pating its  efforts  in  the  localities  where  they 
reside  and  have  influence. 

In  carrying  through  this  Bill,  Mr.  Hardy  has 
done  a  good  work,  and  one  which  ought  to 
gain  him  the  gratitude  of  the  community  at 
large,  one  which  will  certainly  earn  him  the 
thanks  of  those  who  are  best  fitted  to  appre- 
ciate its  necessity  and  importance. 


Erratum. — It  is,  perhaps,  scarcely  neces- 
sary to  say  that  the  name  "Christian"  was  a 
typographical  mistake  for  Christison  in  the 
obituary  notice  of  that  distinguished  Scotsman 
in  our  last  issue. 


AMBITION    AND    LIBERALITY:    THE 
CANADA    LANCET    AND    CONSUL- 
TATION WITH  HOMCEOPATHS. 

We  fear  that  we  must  plead  guilty  to  the 
charge  of  being  ambitious  lately  made  at  the 
hands  of  our  great  city  contemporary  who 
modestly  announces  in  prominent  places 
throughout  his  journal  the  largest  circulation 
of  any  medical  journal  in  Canada.  But  our 
ambition  is  scarcely  equal  to  his  own  in  its 
loftiness  of  flight,  for  "by  that  sin  fell  the 
angels,"  and  we  soar  in  some  directions  only. 
For  instance,  modesty  compels  us  to  decline  the 
honour  of  being  dubbed  the  Organ  of  the 
Toronto  School  of  Medicine,  estimable  and 
worthy  as  that  School  is  justly  deemed  to  be,  and 
our  ambition  prompts  us  to  aspire  to  being  the 
Organ  and  the  mouthpiece  of  the  profession 
throughout  the  Province.  Our  contemporary's 
School  bias  is  so  strong  that  he  can  scarcely 
realize  the  possibility  of  independence,  and 
even  while  charging  us  with  being  ambitious 
he  fails  to  see  that  we  audaciously  desire  to 
represent  his  School  with  all  the  rest.  Our 
ambition,  however,  does  not,  as  does  his  own, 
extend  so  far  as  to  include  the  representation 
and  championship  of  the  interests  of  Homoeo- 
paths and  other  irregulars,  the  enemies  and 
parasites  of  the  profession,  and  for  this  moder- 
ation we  are  duly  thankful  to  the  Fates,  else 
we  should  fear  the  dread  day  of  dissolution  to 
be  approaching,  for  "  Quern  Deus  vuU  perdere 
prius  dementat." 

But  while  we  seem  ambitious  in  the  eyes  of 
our  contemporary,  it,  at  the  same  time,  appears 
to  him  that  we  are  lacking  in  liberality,  because, 
forsooth,  we  cannot  see  the  propriety  of  con- 
sultations with  exclusive  dogmatists,  involving 
as  they  must  a  sacrifice  of  principle  on  the  part 
of  one  or  both  consultants,  or  a  farcical  formality 
devoid  of  every  thing  but  fraud.  If  by  liberality 
is  meant  a  readiness  to  forego  a  principle  at  the 
beck  of  circumstance  or  to  yield  a  point  of  truth 
at  the  call  of  convenience  or  of  profit,  then 
truly  we  must  again  plead  guilty  to  the  naive 
impeachment  of  lacking  liberality.  But  if, 
as  we  opine,  true  liberality  consists  in  the  pur- 
.suit  of  truth  in  every  channel  and  its  accep- 
tance from'Jevery  source,  then  do  we  claim  to 


OF  MEDICAL  SCIENCE. 


129 


be  liberal  as  Science  herself,  and  hold  those 
mosb  illiberal  who  promulgate  an  exclusive 
theory,  or  recognize  the  dogmatists  as  fellow- 
searchers  after  truth.  In  the  matter  of  prin- 
ciple the  Lancets  liberality  smacks  of  chicanery; 
we  cannot  vie  with  it  in  bidding  for  the  sup- 
port of  the  irregulars,  and  in  this  respect  we 
"  fling  away  ambition," 

We   deny   the   correctness   of  the   Lancet^s 
assertion  that  "  professional  courtesies  bet  we  an 
the  homoeopathic  and  regular  practitioners  in 
this  city  ,     .     .    have  been  of  frequent  occur- 
rence," and  we  are  persuaded  that  in  this  and 
previous  articles  we  have  voiced  the  sentiments 
of  at  least  nine-tenths  of  the  prefession  of  the 
Province.     The  Lancet  informs  its  readers  that 
two  prominent  homoeopaths  in  London,   Eng., 
Drs.  Wyld  and  Dudj;eon  "  are  quite  pleased 
with  the  resolution  of  the  Royal  College   of 
Physicians,"   but   it  omits  to  state    that    the 
former  a  few  years  ago,  when  Vice-President 
of  the  Homoeopathic  body  in  England,  made 
a  specific  recantation  of  every  one  of  the  funda- 
mental doctrines  of  homoeopathy  when  seeking 
admission  to  the  London    Medical   Societies; 
and  that  the  latter  is  so  honest  a  homoeopath 
that  he  concurs  entirely  in  the  impossibility  of 
good  resulting  from  such  meetings,  and  declares 
that  he  could  not  conscientiously  consult  with 
any    other  than  a    homoeopathic    practitioner. 
We  are  not  surprised  to  find  our  city  contem- 
porary falling  in  the  rear  in  this  contention  for 
pure  principle  and   not  for  gain,  for  it  is  but 
too  true  "  the  path  of  honour  is  a  ^strait   so 
narrow  where  one  but  goes  abreast,"  but  our 
high    ambition    overvaults    itself  in    the    still 
living  aspiration  that  our  contemporary  may 
yet  be  found  to  follow  in  our  wake  amenable 
at  length  to  the  purifying  influence  of  the  con- 
tagion of  a  good  example. 


UNIVERSITY  OF  TORONTO--MEDICAL 
EXAMINATIONS. 

The  Annual  Spring  Examinations  in  medi- 
cine in  this  University  take  place  this  month. 
We  are  pleased  to  observe  that  at  a  late  meet- 
ing of  the  Senate  the  views  which  we  have 
frequently  promulgated  with  reference  to  the 
appointment  of  examiners  in  such  subjects  as 


anatomy  have  at  length  prevailed.     When  the 
Editor    of    this    Journal    lately    declined   to 
'examine  in  anatomy  and  surgery    (heretofore 
coupled)  on  the  ground    that    he  was   not    a 
teacher  of  the  former  subject  and,  therefore, 
quite  unlikely  to  be  capable  of  properly  conduct- 
ing an  Honours-examination  in  that  department, 
it  appeared  not  unlikely  that  the  question  would 
be  brought  to  a  focus  in  the  Senate,  and  the 
issue    has    happily    been   the    appointment  of 
Dr.  M.  H.  Aikins,  Lecturer  on  Primary  Ana- 
tomy in   the  Toronto  School  of  Medicine,   as 
Examiner  in  Anatomy.     But,  strange  to  say, 
the  union  hitherto  existent  between  anatomy 
and  surgery  has  been  suddenly  divorced,  and  the 
examinership  in  surgery  conferred   on   Dr.  F. 
LeM.  Grassett,  Professor  of  Medical  Jurisprud- 
ence in  Trinity  Medical  School.   Now,  while  we 
can  find  no  fault  on  the  score  of  competency 
with  this   appointment,  Dr.  Grassett,  indeed, 
being  specially  qualified  for  the  post,  we  are 
at  a  loss  to  know  why  the  change  should  have 
been  made  just  at  this  present  juncture,  no 
man  in  the  Province  being  more  capable,  either 
by  reason  of  education  or  of  personal  experience 
of    examining    in    surgery    than  the    newly- 
appointed  examiner  in  anatomy.      A  shrewd 
suspicion  occurs  to  us,  however,  that  this   is 
another  instance  and  evidence  of  a  tendency, 
or  disposition  in  the  Senate  to  pander  to  the 
insane  jealousies   and  ungenerous  rivalries  of 
the  schools.     Against  this,  in  the  name  of  the 
graduates,  we  ardently  protest.   If  an  examiner, 
being  a  schoolman,  cannot  be  trusted  upon  the 
Board  without  having  his  impartiality  and  fair- 
ness corroborated  and  confirmed  by  the  pres- 
ence of  another  examiner  from  a  rival  school, 
he  is  not  a  fit   companion   for   the    indepen- 
dent gentlemen    he    will    be  there   associated 
with,  and  convocation  and  the  world    should 
know  it.     The  fact  still  lacks    demonstration 
that  the  conjunction   of   two   unfair  men  en- 
genders impartiality,  although  "  set  a  thief  to 
catch  a  thief  "  is  a  time-honoured  maxim.  The 
great  body   of   Convocation  utterly  contemns 
and  despises    the   bickerings,  the  wranglings, 
the  jealousies,   and    suspicions  of  the  schools, 
and  the  representatives  of  Convocation  in  the 
Senate  would  do  well  not  only  to  imbibe  but 
also    to    manifest    this   same    spirit   of    inde- 


130 


CANADIAN  JOURNAL 


pendence  of,  and  total  disregard  for,  sectional 
prejudices  and  distempers.  "  Do  right  and 
fear  not "  may  well  be  their  rule  of  life  and 
conduct,  and  we  can  assure  them  that  in  fol- 
lowing it  out  to  the  letter  the  countenance 
and  support  of  their  constituents  will  not  fail 
tliem,  and  the  interests  of  the  University  will 
not  suffer,  nor  be  endangered. 


THE    LIMITS    OF   UNPAID   SERVICE. 

The  Medical  Profession  has  been  appropri- 
ately termed  the  Great  Unpaid  ;  for  indubit- 
ably no  other  class  of  the  community  expends 
so  large  a  portion  of  its  substance,  strength, 
and  time,  and  mind  gratuitously  for  the  service 
and  relief  of  others.  People  do  not  often  notice 
or  remark  the  fact,  for  it  always  has  been  so 
and  must  continue  to  be  so  "  while  the  races 
of  mankind  endure."  The  human  heart  is  in- 
voluntarily moved  to  sympathy  by  the  know- 
ledge of  suffering  or  distress  ;  and  to  the  cry 
of  pain  the  human  hand  intuitively  responds. 
We  dp  not,  therefore,  grudge  the  many  acts  of 
private  charity  in  a  professional  way  which 
every  physician  freely  dispenses,  to  the  world 
unknown.  Nor  yet  do  we  object  to  much  of 
the  gratuitous  service  rendered  in  dispensaries 
and  hospitals,  for  here  there  is  in  a  certain 
sense  a  sort  of  quid  pro  quo,  an  opportunity  of 
partly  satisfying  the  inexorable  thirst  for  know- 
ledge by  study  and  experiment.  But  surely 
the  expectation  of  its  extent  must  attain  finality 
in  the  case  of  the  public  service.  The  people, 
as  a  whole,  can  afford  to,  are  expected  to,  and 
do  pay  well  and  fairly  for  the  benefits  they 
derive  from  the  service  of  the  individual  in  all 
ranks  and  classes  of  the  community.  We  can 
conceive  of  no  reasonable  or  equitable  grounds 
why  an  exception  should  be  made  of  members 
of  the  medical  profession.  It  is  with  consider- 
able surprise  and  disappointment,  therefore, 
that  we  find  the  Ontario  Public  Health  Bill 
passing  its  third  reading  and  becoming  law, 
providing  that  the  Provincial  Board  of  Health 
shall  consist  of  seven  members,  of  whom  at 
least  four  are  to  be  medical  practitioners,  and 
two  only  (the  chairman  and  secretary)  are  to 
receive  remuneration.  The  probabilities  are, 
in  point  of  fact,  that  six  out  of  the  seven  mem- 


bers of  the  Board  will  be  medical  men,  and  the 
proposition  is  that  the  public  should  avail  them- 
selves of  the  brains,  experience,  time,  and  fore- 
sight of  these  gentlemen,  and  give  them  nothing 
in  return,  although  it  has  the  magnanimity  to 
offer  to  defray  their  travelling  expenses  where 
travelling  is  necessary.  We  had  fondly  hoped 
that  the  utmost  limits  of  unpaid  service  would 
fall  far  short  of  the  public  service ;  and,  in  spite 
of  recent  indications  of  the  contrary,  we  still 
hold  most  strongly  that  the  least  that  could  be 
done  would  be  to  pay  these  gentlemen  at  con- 
sultation rates  for  their  loss  of  time  whenever 
they  are  called  upon  to  meet  in  consultation  on 
the  public  health.  It  is  inexplicable  to  us  how 
this  piece  of  simple  justice  to  the  profession 
could  have  been  omitted  in  a  House  number- 
ing amongst  it  members  so  many  doctors  as 
does  the  Provincial  Legislature  of  Ontario. 


THE  ONTARIO   MEDICAL  COUNCIL- 
ITS  FUNCTIONS  AND  USE. 

From  an  editorial  in  the  Woodstock  Times, 
part  of  which  is  elsewhere  quoted,  and  from 
remarks  by  laymen,  often  heard  in  private  con- 
versation, it  is  evident  that  many  people  be- 
lieve that  the  Medical  Council  of  Ontario  exists 
solely  for  the  protection  and  advantage  of  the 
Medical  Profession.  No  misconception  could 
be  more  egregious.  For,  in  point  of  fact,  the 
public,  and  the  public  solely,  are  the  great 
beneficiaries  by  its  existence.  It  is  quite  true 
that  the  medical  men  in  the  Province  were 
chiefly  instrumental  in  securing  the  passage  of 
the  Act  whereby  the  College  of  Physicians 
and  Surgeons  of  Ontario  was  erected.  But  in 
what  good  work  in  the  public  interest,  as  far 
as  medical  influence  can  be  felt,  do  they  not 
take  a  foremost,  self  sacrificing  part  ?  The  chief 
use  of  the  Council  is  to  further  and  improve 
the  work  of  medical  education  in  the  Province  I 
and  its  chief  function  is  to  test  and  stamp  with 
the  mark  of  its  approval  every  candidate  fitted 
for  the  legal  practice  of  physic.  But  whom 
does  this  advantage  1  Surely  not  existing  prac- 
titioners, for  it  must  be  easier  for  them  to  com- 
pete with  uneducated  than  with  educated  men  1 
Surely  the  people  are  the  gainers,  for  they 
therein  have  a  means  of  knowing  who  are  fairly 


OF  MEDICAL  SCIENCE. 


131 


qualified  to  be  entrusted  with  their  lives  and 
limbs,  and  who  "are  mere  pretenders  to  the 
name."  Again,  it  may  be  urged  that  registered 
practitioners  secure  by  the  Act  the  right  to 
recover  their  just  dues  by  legal  process ;  but 
on  the  other  hand  the  fact  must  not  be  lost 
sight  of  that  physicians  have  the  remedy  of 
such  abuses  in  their  own  hands,  by  demanding 
pre-payment  of  their  services.  The  penal  clauses 
of  the  Act  are  practically  largely  impotent, 
and  after  all  the  punishment  of  quacks  does 
not  profit  much  the  physician's  purse,  since 
they  probably  make  as  much  work  for  him  as 
they  deprive  him  of ;  it  does,  however,  conduce 
materially  to  the  public  safety. 

On  the  whole,  then,  we  opine  that  the  Pro- 
fession and  its  Press  can  afibrd  to  smile  at  the 
empty  threat  we  have  lately  heard  from  the 
Woodstock  Times,  et  hoc  gembs  omn«,  about  the 
abolition  of  a  "  monopoly,"  and  "  privileges  " 
by  the  people's  representatives  in  Parliament. 
The  repeal  of  the  Ontario  Medical  Act  would 
concern  the  doctors  personally  but  little,  or  not 
at  all ;  it  is  the  people's  vital  interests  which 
are  involved  in  its  integral  maintenance  or 
amendment.  The  public  press  is  blind  if  it 
cannot  see  that  fact ;  and  the  end  of  "  blind 
leaders  of  the  blind  "  is  in  "  the  ditch." 


NEWSPAPER  OFFENCES  AGAINST 
THE  PROFESSION. 

From  the  replies  elicited  by  the  article 
having  the  above  caption  in  our  last  issue, 
from  the  Woodstock  Times  and  the  Arthur 
Enterprise,  it  appears  that  we  have  personally 
verified  the  ancient  metaphorical  proverb,  "If 
you  cast  pearls  before  swine  they  will  turn 
again  and  rend  you."  Both  papers,  as  was 
perhaps  to  be  expected,  view  the  matter  solely 
from  the  lay,  unprofessional  standpoint ;  and 
both  are  wilfully  blind  to  the  generally  recog- 
nized fact  that  preparation  for  and  practice  in 
any  one  of  the  three  learned  professions  do 
powerfully  tend  to  a  refinement  of  feeling  and 
delicacy  of  perception  which  distinctly  separate 
their  object  from  the  profanum  vulgus  in  mat- 
ters ethical  and  aesthetic.  Accordingly  there 
are  many  circumstances  in  which  what  may  be 
inoffensive,  and  even  pleasing  to  one  man,  may 


be  utterly  abhorrent  to  the  finer  suscejjtibilities 
of  another.  Modesty — personal,  aelf  or  indi- 
vidual subordination — is  amongst  the  most 
constant  outcomes  of  scientific  training ;  and 
to  the  true  disciple  of  Hippocrates,  the  private 
character  of  whose  calling  is  unequalled  even 
by  that  of  the  spiritual  adviser,  publicity  in 
the  discharge  of  duty  is  the  quintessence  of 
abominations.  We  should  very  much  like  to 
reproduce,  in  exteriso  in  our  columns,  the  views 
of  our  lay  contemporaries  for  the  edification  of 
our  readere  ;  but  lack  of  space  will  not  permit. 
Neither  can  we  enter  into  a  controversy  with 
the  writers  on  the  subject  failing  to  find  a 
common  ground  of  meeting  or  understanding  ; 
and  the  only  criticism  we  are  disposed  to  make 
is  that  we  do  not  believe  that  the  adoption  of 
more  gentlemanly  language  in  the  statement 
of  their  views  would  in  any  wise  detract  from 
the  force  or  pertinence  of  their  observations. 


THE    LETTKR    OF    "  MEDICUS "    AND 
THE  MEDICAL  SCHOOLS. 

Our  homoeopathic  contemporary  of  this  city, 
in  an  article  entitled  "  The  Ontario  Medical 
Council  and  its  (friends  1)  "  in  the  March  num- 
ber, expresses  regret  that  we  should  publish  a 
"  letter  written  with  the  transparent  purpose 
of  injuring  any  of  our  well-conducted  medical 
schools,"  and  in  the  Journal  of  the  same  month 
Dr.  Geikie  complains  of  an  "  attack  made  on 
one  of  our  schools."  In  the  first  place  there 
was  no  attack  made  on  any  school,  but  only  a 
comparative  statement  given,  showing  the  per- 
centage of  the  rejected  from  each  of  the  schools, 
sending  students  up  to  the  Council  examina- 
tion held  last  spring.  In  the  second  place  this 
statement  was  not  given  for  the  purpose  of 
injuring  any  teaching  institution,  but  simply 
as  a  reply  to  the  unjust  accusations  of  dis- 
honesty and  partiality  against  one  of  the 
examiners.  It  was  openly,  as  well  as  privately, 
stated  that  the  examiner  in  question  had 
favoured  the  Kingston  students,  and,  in  order 
to  carry  out  more  easily  such  an  iniquitous 
procedure,  had  used  diff'erent  coloured  paper  in 
Kingston.  What  more  natural  after  such  a 
statement  than  an  analysis  of  the  results  which 


ISS 


CANADIAN  JOURNAL 


is  so  displeasing  to  one  who  encouraged  letter 
writing  last  summer  1 

We  quite  agree  with  the  assertion  that  the 
percentage  from  the  different  schools  varies 
from  year  to  year,  and  if  at  the  next  examina- 
tion the  school  which  was  least  successful  at 
the  last  happens  to  head  tho  list,  we  shall  cheer- 
fully give  the  fact  all  the  prominence  in  this 
journal  which,  under  the  circumstances,  it  is 
fairly  entitled  to. 


TORONTO   SCHOOL  OF  MEDICINE 
MEDICAL  SOCIETY. 

The  first  annual  meeting  of  this  Society  for 
the  election  of  officers  and  reception  of  reports, 
<fcc.,  was  held  at  the  building  of  the  school, 
March  10th.  The  report  of  the  General  Com- 
mittee showed  a  membership  of  one  hundred 
and  two  in  addition  to  the  members  of  the 
faculty.  The  students  have  found  the  reading- 
room  and  library  a  great  benefit,  and  have 
availed  themselves  largely  of  the  privileges 
connected  therewith.  The  leading  daily  papers 
from  the  principal  cities  of  Canada,  many 
weeklies,  magazines,  and  a  number  of  medical 
journals  have  been  kept  on  file.  The  library 
contains  a  number  of  books,  and  during  the 
summer  many  others  will  be  added. 

Great  interest  was  taken  in  the  elections 
which  resulted  as  follows  :  President,  Dr.  A.  H. 
Wright  (by  acclamation)  ;  first  Yice- President, 
Mr.  J.  W.  Meldrum  ;  second  Vice-President, 
Mr.  J.  W.  Patterson,  M.A.  ;  Recording-Secre- 
tary, Mr.  J.  Spence;  Treasurer,  Mr.  A.  T. 
Rice ;  Corresponding-Secretary,  Mr.  F.  P. 
Drake;  Curator,  Mr.  H.^  A.- Wright ;  Coun- 
cillors, Messrs.  F.  J.  Dolsen,  B.A.,  W.  J. 
Robinson,  W.  J.  Lepper,  G.  S.  Wattam,  B.A., 
and  H.  S.  Martin, 


ADMONITORY. 

Nisi  se  meliiis  gesserint 
"  Delenda  est  Carthago," 


the  Canadian  Journal  of  Medical  Science  may 
choose  to  say  that  we  are  guilty  of  '  offences 
against  the  profession.'  We  have  a  word  of 
advice  to  give  the  editors  in  question.  A 
conviction  is  becoming  general  in  the  minds  of 
the  public,  that  the  Ontario  Medical  Trades' 
Union  Act  requires  great  amendment,  and  if 
they  wish  to  conserve  their  privileges  and 
maintain  their  monopoly,  the  less  they  have  to 
say  about  *  newspaper  offences  against  the 
profession,'  the  better  for  themselves."  We 
trust  the  Profession  will  forgive  us  for  incur- 
ring this  dreadful  commination  which  threatens 
to  involve  the  body  medical  in  ruin. 


Says  the  Woodstock  Times  of  30th  ^March  : 
"  Doctors  who  do  well,  and  are  prompt,  tender, 
and  careful  in  the  performance  of  their  duties, 
will  always  find  a  word  of  commendation  in 
our  columns,  and  those  who  are  the  reverse, 
may  be  thankful  we  pass  over  their  laches  in 
silence,  even  although  the  priggish  editors  of 


THE  SECRETARYSHIP  OF  THE  BOARD 
OF  HEALTH. 

The  success  of  the  newly-appointed  Provincial 
Board  of  Health  will  doubtless  depend  in  large 
measure  upon  the  zeal  and  capacity  of  its  Secre- 
tary, upon  whom  will  devolve  the  lion's  share  of 
the  labour,  and  no  slight  responsibility.  We 
think,  therefore,  that  a  mistake  has  been  made 
in  limiting  his  salary,  by  Act  of  Parliament,  to 
one  thousand  dollars  per  annum.  This  sum  is 
totally  inadequate  to  attract  to  the  office  any 
man  of  experience  and  standing  in  the  profes- 
sion. We  should  much  like  to  have  seen  a 
sufficient  appropriation  for  this  purpose  made 
to  Lave  induced  some  one  of  the  older  heads  in 
the  profession,  well  versed  in  the  nature  of 
men  and  things,  well  read  in  the  literature  of 
pi-eventive  medicine,  well  trained  in  intellect 
and  judgment,  well  acquainted  with  the  special 
needs  and  requirements  of  our  country,  and, 
above  all,  "  well  fouled  in  kind  by  the  dirtjp- 
nurse.  Experience,"  to  be  content  to  abandon 
practice  for  the  future,  and  devote  the  full 
energy  and  ripe  experience  of  his  declining 
years  to  the  inauguration  and  permanent 
establishment  in  our  midst  of  a  satisfactory, 
efficient,  vigorous,  and  comprehensive  system 
of  health-maintaining,  disease-recording  and 
preventing  Government. 


De.  Matthew  D.  Mann  has  been  elected 
the  late  James  P.  White's  successor  in  the 
Chair  of  Obstetrics  and  Diseases  of  Women,  in 
the  University  of  Buffalo. 


OF  MEDICAL  SCIENCE. 


133 


CHAIRMANSHIP  OF  THE  PROVINCIAL 
BOARD  OF  HEALTH. 
Members  of  the  Profession  throughout  the 
country  will  be  glad  to  know  that  William 
Oldright,  M.A.,  M.D.,  (University  of  Toronto) 
of  this  city,  Lecturer  on  Sanitary  Science  in 
the  Toronto  School  of  Medicine,  has  been  pro- 
perly selected  by  the  Ontario  Government  for 
the  Chairmanship  of  the  Provincial  Board  of 
Health,  as  having  probably  paid  more  attention 
to  the  subject  than  any  man  in  the  Province. 
We  trust  that  his  experience  on  the  Board  may 
fully  convince  him  that  in  another  sphere  of 
public  utility — the  Senate  of  the  University  of 
Toronto — he  may  greatly  further  the  great  and 
good  work  just  begun,  and  establish  a  further 
claim  upon  the  gratitude  of  his  fellow-citizens 
by  securing  a  post-graduate  examination  for 
Sanitary  Science  Certificates,  as  Cambridge  and 
Dublin  have  already  done.  Here  members  of 
the  great  life-saving  army  of  medical  officers 
of  health  may  properly,  as  we  have  long  con- 
tended, have  their  special  fitness  for  the  dis- 
charge of  their  important  duties  duly  tested 
and  attested. 


A  DISCLAIMER. 

The  Arthur  Enterprise  in  a  late  editorial 
insinuates  that  in  our  last  issue  we^endeavoured 
to  hit  Dr.  McKinnon,  of  Guelph,  over  its 
shoulder.  We  should,  indeed,  be  sorry  to  have 
any  such  impression  go  abroad.  Should  oc- 
casion ever  demand  the  casting  of  an  editorial 
dart  in  that  direction  we  shall  not  be  foolish 
enough  to  attempt  to  penetrate  the  protecting 
aegis  of  a  country  newspaper.  For  the  present, 
however,  we  have  neither  occasion  nor  desire 
to  quarrel  with  the  worthy  doctor,  having  every 
reason  to  regard  him  as  a  highly  honourable 
and  straightforward  man — in  other  words,  a 
gentleman — and  a  most  intelligent  practitioner. 
Moi*eover,  we  doubt  not,  both  from  his  letter 
in  our  columns  some  time  ago,  and  again  to-day, 
and  upon  general  principles,  he  is  ready  to 
endorse  every  word  we  have  written  anent  the 
"newspaper  oflfences  against  the  profession." 
«i*»»  ■ 

Professor  Freund,  of  Strasbourg,  is  reported 
to  have  been  offered  and  to  have  accepted  the 
chair  of  Obstetrics  in  Breslau,  formerly  occu- 
pied by  the  late  Professor  Spiegelberg. 


EXAMINATIONS. 
Among  the  students  at  the  present  time 
there  is  the  usual  excitement  over  the  ever- 
dreaded  examinations  which  are  going  on. 
The  most  important  feature  is  the  fact  that 
they  are  every  year  becoming  more  practical, 
and,  therefore,  more  useful  in  a  proportionate 
degree.  To  the  Council  must  be  given  full 
credit  for  its  persistent  efforts  in  this  direction 
during  the  last  few  years.  At  the  examina- 
tion to  be  held  by  that  body  in  April  we  notice 
with  pleasure  that  the  students  will  be  sub- 
jected to  a  thoroughly  practical  test  in  both 
primary  and  final  subjects.  The  various  uni- 
versities (especially  Toronto)  are  advancing  in 
the  same  direction,  and  becoming  more  prac- 
tical every  year.  From  a  pretty  close  observa- 
tion of  the  students  of  this  city  during  the 
session  now  completed,  we  can  bear  testimony 
to  the  unusual  assiduity  exhibited  by  them 
both  in  hospital  and  school  work,  and  we  have 
much  pleasure  in  wishing  them,  one  and  all, 
the  highest  success. 


TO  THIS  YEAR'S  GRADUATES. 

At  the  expense  of  considerable  space,  we 
reproduce  in  this  issue,  from  the  Medical  News, 
for  the  benefit  of  our  graduating  classes  this 
year,  the  admirable  Valedictory  Address,  pro- 
nounced last  month  by  Surgeon  John  S.  Billings, 
M.D.,  to  the  graduates  of  Bellevue  Hospital 
Medical  College.  We  sincerely  Irust  that  those 
young  men  who,  simultaneously  with  this  issue, 
now  go  out  into  the  world,  will  ponder  the 
wisdom  it  pithily  expresses  well,  and  pay  due 
heed  to  the  wise  precepts  and  sage  maxims  it 
contains;  for  wise  men  acquire  from  the  experi- 
ence of  others  those  wholesome,  although  bitter, 
truths,  which  fools  learn  only,  and  that  not 
easily,  for  themselves. 


A  correspondent  tells  us  there  are  fifty  doc- 
tors in  Winnipeg  with  a  population  of  about 
fifteen  thousand,  and  others  are  coming  every 
week.  The  Free  Press  of  that  city  says  they 
are  becoming  as  numerous  as  land  agents. 

Albrecht  Von  Graefe. — A  memorial  statue 
of  this  illustrious  Ophthalmologist  has  been 
erected  in  Berlin.  It  will  be  unveiled  on  the 
22nd  May,  his  birthday. 


134 


CANADIAN  JOURNAL 


Lectures  at  the  Ontario  College  of 
Pharmacy, — We  are  much  pleased  to  observe 
that  the  College  has  at  length  seen  its  way  to 
the  filling  of  a  hiatus  hitherto  existent  in  the 
sphere  of  its  utility,  by  the  establishment  of  a 
course  of  lectures  at  which  young  men  may  be 
prepared  for  the  examinations  of  that  body, 
which  every  one  desirous  of  practising  phar- 
macy in  Ontario  is  now  obliged  to  pass.  The 
following  lecturers  have  been  chosen: — Messrs. 
E.  B.  Shuttleworth^  H.  J.  Rose,  W.  T.  Robin- 
son, and  H.  Montgomery,  M.A.,  B.  Sc;  their 
respective  subjects  being  chemistry  and  phar- 
macy, materia  medica,  demonstrations  in  dis- 
pensing and  botany.  An  assistant  to  the 
lecturer  on  chemistry  will  also  be  appointed. 
The  spring  term  extends  from  April  4th  to 
July  14th.  From  the  staff  selected  it  will  be 
seen  that  the  course  will  be  inaugurated  with 
every  earnest  of  success,  and  this  in  the  fullest 
measure  we  wish  it  heartily. 


University  of  Victoria  College. — The 
Examinations  in  Medicine  of  this  University 
have  been  held  in  the  Medical  Council  Chamber, 
Bay  Street,  on  the  30ch  and  31st  ult.  and 
will  be  brought  to  a  conclusion  to-day  (1st 
April).  Following  is  a  list  of  the  examiners: 
Chemistry  and  Botany,  M.  Barrett,  M.A., 
M  D.  ;  Anatomy,  W.  J.  Wagner,  M.B.;  Medi- 
cal Jurisprudence  and  Materia  Medica,  W.  W. 
Ogden,  M.B.;  Medicine  and  Physiology,  A. 
h!  Wright,  B.A.,  M.B.,  M.R.C.S.,£ng.,  Mid- 
wifery and  Gynaecology  and  Surgery,  I.  H. 
Cameron,  M.B. 


3?oofe  §tft\m. 


The  Popular  Science  Monthly  is  again  be- 
fore us.  Tne  April  number  contains  nineteen 
articles  amongst  which  the  following  will 
specially  interest  medical  men  :  "  The  Scholas- 
tic Prelude  to  Modern  Science,"  by  H.  D. 
Macleod,  M.A.  ;  "  Has  Science  yet  Found  a 
New  Basis  for  Charity  1"  by  Professor  Goldwin 
Smith  ;  "  Recent  Wonders  of  Electricity,"  by 
W.  H.  Preece,  F.R.S.  ;  "  The  Germ  Theory," 
Prof.  Louis  Pasteur ;  "  Dean  Swift's  Disease," 
by  Dr.  Bucknill,  F.R.S.,  and  a  "Sketch  of 
Louis  Pasteur,"  (with  portrait).  We  know  of 
no  periodical  to  which  our  readers  can  more 
profitably  subfcribe.  The  publishers  are  Messrs. 
D.  Appleton  <k  Co.,  New  York.  The  yearly 
subscription,  $5.00    Single  number  50  cents. 


The  Case  o/Guiteau. — A  Payclwlogical  Study. 
By  Geo.  M.  Beard,  M.D.,  New  York.  (Re- 
print from  Journal  of  Nervous  and  Mental 
Diseases,  Vol.  IX). 

Vascular  Tumours  of  the  Female  Urethra, 
with  a  Description  of  a  Speculum,  Devised  to 
Facilitate  their  Removal.  By  A.  Reeves 
Jackson,  A.M.,  M.D.,  Chicago,  111.  (Reprint 
from  Vol.  II.,  Gynaecological  Transactions. 


Nervous  Diseases :  Their  Description  and  Treat- 
ment. By  Allan  McLane  Hamilton,  M.D., 
Fellow  of  the  New  York  Academy  of  Medi- 
cine, Physician  at  Hospital  for  Epileptics 
and  Paralytics,  &c.  Philadelphia :  Henry  C. 
Lea's  Son  «te  Co. 

This  work  is  written  for  the  general  practi- 
tioner and  the  student,  and  the  author's  aim  is 
to  write  a  treatise  on  Nervous  Diseases  which 
is  both  concise  and  practical,  while  it  is  at  the 
same  time  sufficiently  comprehensive.  We  have 
pleasure  in  bearing  testimony  to  the  fact  that 
his  efforts  have  been  crowned  with  success. 
There  is  nothing  striking  in  the  style  of  writing, 
nor  evidence  of  great  scientific  research,  but 
the  various  diseases  have  been  well  described, 
the  directions  as  to  how  to  arrive  at  a  correct 
diagnosis  are  very  clear,  and  the  hints  in  treat- 
ment are  plain,  practical,  and  sound.  This  is 
the  second  edition,  the  first  having  appeared  in 
'78,  and  is  far  from  being  a  simple  reprint ; 
indeed,  so  much  has  been  added,  and  so  many 
changes  have  been  made,  that  it  may  almost  be 
considered  a  neW  work.  The  rather  numerous 
typographical  errorsof  the  first  edition  have  been 
mostly  corrected,  although  a  few  old  mistakes 
are  repeated,  such  as  tr.  nux  vomica,  and  new 
ones  occur,  Rj.  strychinse  sulphas,  etc. 

A  very  valuable  feature  of  the  book  is  the 
citation  of  cases  in  practice  to  illustrate  the 
different  diseases,  or  different  phases  of  the 
same  disease.  Chapter  XII.  on  Diseases  of 
the  Lateral  Columns  of  the  Cord,  is  new, 
and  a  great  deal  that  is  new  is  given  in  other 
chapters  on  the  spinal  cord  and  cerebrum, 
especially  on  the  localization  of  diseases  in 
these  organs.  The  plates  are  good,  many 
being    taken    from    Charcot,  Gowers,  Clarke, 


OF  MEDICAL  SCIENCE. 


135 


Fothergill,  and  others,  all  being  duly  acknow- 
ledged. The  author  draws  largely  from  the 
various  authorities,  but  at  the  same  time, 
gives  clearly  his  own  views'  attained  through 
a  wide  experience  in  the  treatment  of  these 
diseases. 

We  need  hardly  say  that  sucn  a  book  should 
be  considered  a  necessity  in  every  medical 
library,  as  the  ailments  described  are  among 
the  most  common  that  come  under  observa- 
tion in  the  every-day  work  of  the  general 
physician.  To  him,  therefore,  we  recommend 
it  with  pleasure  ;  in  fact  we  may  go  farther 
and  say,  that  all  things  considered,  it  is  for  his 
purpose  the  best  book  of  the  kind  now 
available,  except  perhaps  the  larger  work  of 
Ross,  of  Manchester. 


A  System  of  Surgery,  Theoretical  and  Practical, 
in  Treatises  hy  Various  Authors.  Edited  by 
T.  Holmes,  M.A.,  Cantab.  First  American 
from  second  English  edition.  Thoroughly 
revised  and  much  enlarged.  By  John  H. 
Packard,  A.M.,  M.D.,  of  Philadelphia,  as- 
sisted by  a  large  cor{)S  of  the  most  eminent 
American  surgeons.  In  III.  Vols.,  with 
many  illustrations.  Philadelphia  :  Henry  C. 
Lea's,  Son,  &  Co.,  1882.  Toronto:  Hart  & 
Co.,  King  St.  West. 

The  appearance  of  Volume  III.  completes 
the  American  re-print  of  this,  the  best  and 
most  authoritative  Treatise  on  Surgery  which 
has  yet  appeared  in  the  English  language.  The 
subjects  comprised  in  this  volume  are  :  Diseases 
of  the  Respiratory  Organs,  Diseases  of  the 
Bones,  Joints,  and  Muscles,  Diseases  of  the 
Nervous  System,  Gunshot  Wounds,  Operations 
and  Minor  Surgery,  and  Miscellaneous  Subjt^cts, 
including  Diseases  of  the  Breast,  Diseases  of 
the  Skin,  Parasites,  Venomous  i^Insects  and 
Reptiles,  the  Surgical  Diseases  of  Childhood, 
Surgical  Diagnosis  and  Regional  Surgery,  and 
Hospitals.  Apart  from  additions  and  inter- 
polations scattered  throughout,  the  sections 
wholly  American  are :  Operations  upon  the 
Arteries,  Trephining,  Colotomy,  and  Excision 
of  the  Rectum,  by  John  H.  Packard.  One 
hundred  pages  on  Diseases  of  the  Skin,  by 
Arthur  Van  Harlingen ;  and  an  appendix  to 
the  chapter  on  Hospitals.  Thus  presented. 
Holmes'  System"^  of  Surgery  may  fairly  be 
regarded  as  the  chief  exponent  of  the  surgical 


science  of  the  day.  We  fear  to  add  anything 
to  what  we  have  said  in  former  notices,  lest  we 
should  seem  capable  of  fulsome  flattery.  Doubt- 
less we  might  point  out  many  deficiencies  or 
defects  if  at  all  bypercritically  inclined  ;  but 
we  are  not  of  the  optimistic  school,  which  looks 
for  absolute  perfection  in  hyman  enterprifes, 
and  we  are  glad  to  recognize  in  this  composite 
production  of  many  minds  a  fair  and  reason- 
able realization  of  a  high  ideal.  Comment  on 
the  Publisher's  work  would,  at  this  day,  be 
indeed  superfluous,  and  we  shall  only  say  that 
those  who  have  the  work  in  the  half  Russia 
binding,  possess  a  substantial  friend  and  com- 
panion, at  once  pleasing  to  the  eye  and  instruc- 
tive to  the  mind. 


Report  Relating  to  the  Registration  of  Births, 
Marriages,  and  Deaths  in  the  Province  oj 
Ontario,  for  the  year  ending  31  si  December, 
1880.  Appended  to  which  is  a  review  show- 
ing the  results  of  the  working  of  the  Regis- 
tration Act  from  1870  to  1880,  inclusive- 
Printed  by  order  of  the  Legislative  Assembly. 

It  is  regrettable  that  the  vital  statistics  of 
Ontario  for  1?80  should  only  lie  upon  our 
table  now ;  but  under  present  circumstances 
this  delay  seems  inevitable,  the  report  having 
to  be  presented  to  Parliament  before  being 
made  public.  Under  the  auspices  of  the  newly 
created  Provincial  Board  of  Health  we  hope 
soon  to  be  in  possession  of  weekly  and  quarterly 
returns.  The  present  Report  bears  gratifying 
evidence  of  great  improvement  in  the  com- 
pleteness of  its  subject  matter;  and,  though 
still  manifesting  much  room  for  further  achieve- 
ments in  that  direction,  still  affords  reason  and 
opportunity  for  congratulation  on  what  has 
been  accomplished.  The  Review  of  the  Ten 
Years'  Working  of  the  Act  is  a  very  interesting 
feature  of  the  present  Report ;  and  has  been 
as  ably  handled  by  Mr.  H.  S.  Crewe  as  was 
pos&ible  to  a  layman.  We  much  regret  that 
pressure  on  our  space  forbids  analysis  or  com- 
ment. Another  opportunity,  however,  may, 
perhaps,  present  itself. 


Dr.  Theo.  S.  Covernton,  late  of  the  Toronto 
Asylum  for  the  Insane,  has  settled  in  practice 
in  Winnipeg,  in  partnership,  we  believe,  with 
Dr.  Kittson,  late  of  Hamilton. 


136 


CANADIAN  JOURNAL 


Peetittflis  at  pcilial  f  orUtU$. 


NORTH-WESTERN    BRANCH   OF    THE 
ONTARIO  MEDICAL  ASSOCLA.TION. 

The  first  regular  meeting  of  the  above 
Association  was  held  in  Palmerston,  on 
Wednesday,  Feb.  15th.  The  following  mem- 
bers were  present :  Drs.  Clarke,  CoUinge,  and 
Stewart,  of  Palmerston  ;  Nichol,  Philp,  Dilla- 
bough,  Burgess,  and  Dingman,  of  Listowel  ; 
Allan  and  Cowan,  of  Harriston ;  Yeomans, 
Ecroyd,  and  Jones,  of  Mount  Forest ;  McLaren, 
Baird  and  McArton,  of  Paisley ;  Holmes  and 
Graham,  of  Brussels  ;  Martyn,  of  Kincardine  ; 
Stalker,  of  Ripley ;  Mackid,  of  Lucknow ; 
Clapp,  of  Mildmay ;  Hodge,  of  Mitchell ; 
Gun,  of  Durham  ;  Holstein,  of  Cedarville,  and 
Stewart,  of  Brucefield. 

Communications  were  received  from  Drs. 
Henderson,  of  Arthur ;  C.  E.  Barnhart,  of 
Owen  Sound  ;  Robertson,  of  Markdale ; 
Hyndman,  ot  Exeter  ;  Sloan,  of  Blyth  ;  Gillies, 
of  Teeswater  ;  McDonald,  Bethune,  and  Tam- 
blyn,  of  Wiagham,  regretting  their  inability  to 
attend. 

During  the  early  part  of  the  meeting  the 
chair  was  occupied  by  Dr.  Clarke,  of  Palmer- 
ston, and  afterwards  by  the  President,  Dr. 
Yeomans,  of  Mount  Forest. 

Dr.  Collinge,  of  Palmerston,  read  a  very 
carefully  prepared  report  of  a  case  of  Gangrene 
which  he  had  recently  under  observation.  The 
patient  was  a  married  woman,  aged  32,  who, 
when  she  first  came  under  Dr.  Collinge's  care, 
on  the  29th  of  July,  1881,  complained  of  a 
pain  in  the  lumbar  region,  general  weakness, 
and  a  disgharge  fr^>m  the  vagina.  On  examin- 
ation there  was  found  some  abrasion  around  the 
OS  uteri, ijWhich,  _with  the  discharge,  entirely 
disappeared  in  a  week  after  the  application  of 
nitric  acid.  On  the  4th  of  August  she  com- 
plained of  numbness  and  loss  of  power  in  the 
left  arm,  followed  in  a  few  days  by  a  similar 
condition  of  the  right  arm.  She  vomited  fre- 
quently, became  drowsy  and  semi-conscious. 
A  blister  to  the  nape  of  the  neck  was  followed 
by  a  permanent  disappearance  of  the  cerebral 
symptoms.  On  the  17th  of  August  she  was 
suddenly   seized    with    a    violent  paiu  in   the 


gluteal  I'egion,  extending  down  the  outside  of 
the  thigh.  The  right  thigh  and  leg  were 
found  to  be  larger  than  the  left.  On  the  24th 
of  August  the  right  great  toe  had  a  purplish 
hue,  and  was  painful.  In  a  few  days  the  color 
was  changed  to  a  white,  mottled  appearance, 
and  the  gangrenous  process  had  now  involved 
the  whole  foot.  There  was  a  line  of  hardness 
along  the  course  of  the  right  internal  saphenous 
vein  in  the  lower  part  of  the  thigh.  The 
gangrene  steadily  progressed  until  an  oblique 
line  of  demarcation  formed,  four  inches  above 
the  ankle-joint.  Previous  to  her  death,  on  the 
28th  of  September,  the  gangrene  had  extended 
upwards  to  within  four  inches  of  the  knee- 
joint,  and  the  soft  tissues  over  the  sacrum,  to 
the  extent  of  5x3  inches,  sloughed  away.  The 
great  toe  of  the  left  foot  was  livid  and  painful 
The  reading  of  this  paper  was  followed  by  a 
discussion,  in  which  Drs.  Allen,  Cowen,  Clarke, 
Burgess,  Gun,  McLaren,  Clapp,  and  others 
took  part. 

Dr.  Graham,  of  Brussels,  read  a  paper  on 
"  Pernicious  Anaemia."  He  gave  the  details  of 
two  cases  which  well  illustrate  the  wonderful 
hseraatinic  powers  possessed  by  arsenic.  The 
first  case  was  that  of  a  married  woman,  aged 
35,  who  was  found  in  the  following  state  five 
weeks  after  her  confinement :  The  haemorr- 
hage during  the  labour  was  trifling.  Her  face 
was  swollen  and  bloodless.  Mucous  membranes 
pale.  Troubled  frequently  with  diarrhoea  and 
vomiting.  She  had  frequent  and  severe 
pyrexial  attacks.  The  blood  was  found  to 
contain  a  large  number  of  microcytes.  The  red 
corpuscles  varied  much  in  form.  There  was 
no  increase  in  the  number  of  white  cells. 
Under  quinine  and  iron  she  became  rapidly 
worse.  Under  arsenic  she  rapidly  and  per- 
manently recovered.  The  second  case  is  a 
somewhat  similar  one,  occurring  in  a  female, 
aged  24,  who  two  weeks  after  her  confinement 
presented  the  well-known  symptoms,  including 
the  pyrexial  attacks  of  pernicious  anaemia. 
Arsenic  was  soon  followed  by  complete  re- 
covery. 

Dr.  Stewart,  of  Brucefield,  read  a  paper  on 
"  Some  of  the  Uses  of  the  Sphygmograph  in 
Practical  Medcine." 

Traces,  illustrative  of  the  actions  of  alcohol, 


OF  MEDICAL  SCIENCE. 


137 


digitalis,  nitro-glycerine,  and  other  drugs,  were 
shown.  Traces  were  also  shown  which  prove 
that  in  many  cases  of  pneumonia,  even  during 
the  first  twenty-four  hours,  the  tension  of  the 
radial  artery  is  much  lowered. 

Drs.  Yeomans,  Mackid,  Burgess,  and  Clapp 
w;ere  appointed  to  read  papers  at  the  next 
meeting  of  the  Association,  which  will  be  held 
in  Palmerston,  two  or  three  weeks  after  the 
meeting  of  the  Ontario  Association. 


^^imXimtm^. 


ADDRESS      TO      THE      GRADUATING 

CLASS  OF  BELLEVUE  HOSPITAL 

MEDICAL  COLLEGE. 

Delivered  March  15th,  1882. 

BY    JOHN    S.    BILLINGS,    M.D., 

Surgeon  U.  S.  Army, 

I  vaguely  remember  that  once  upon  a  time — 
a  long  while  ago  it  seems,  for  I  look  back  at  it 
across  the  gulf  of  a  great  war,  in  which  the 
days  were  like  weeks,  and  the  months  almost 
counted  for  years — I  spent  one  evening  on  a 
platform  in  a  large  hall,  in  the  character  of  a 
new  graduate  in  medicine.  A  part  of  the 
ceremonies  on  that  auspicious  occasion  con- 
sisted of  a  valedictory  address  to  the  graduates, 
delivered  by  the  most  eloquent  member  of  the 
faculty — an  address  which  was  highly  praised, 
but  of  which  I  have  vainly  tried  to  remember 
either  the  ideas  or  the  phraseology.  Fearing 
that  this  specially  localized  loss  of  memory 
might  be  a  symptom  of  a  new  nervous  disease 
which  I  should  have  to  name  and  describe,  I 
have  consulted  several  of  my  medical  friends 
as  to  their  experience  in  this  respect,  and  I  am 
much  pleased  to  be  able  to  say  that  I  have 
found  very  few  who  have  not  totally  forgotten 
the  words  of  congratulation  and  of  counsel 
given  to  them  when  thsy  received  their 
diplomas. 

Nor  is  the  reason  of  this  far  to  seek.  The 
new  doctor,  in  the  pride  and  vigour  of  youth, 
just  stepping  out  of  leading-strings,  and  realiz- 
ing that  he  is  really  his  own  man  at  last — 
standing  at  the  threshold  of  that  wonderful, 
glittering  world  which  beckons  him  on  so  en- 
ticingly, and   in    which    fame,  and  love,   and 


wealth  await  his  coming — this  learned  and 
skilful  physician  is  held  back  yet  another  hour, 
and  compelled  to  listen  to  advice  from  one 
whom  he  does  not  know,  but  who  can  surely 
have  nothing  to  tell  him  beyond  some  well- 
worn  platitudes  about  the  dignity  and  honour 
of  the  profession  which  he  has  chosen,  and  that 
if  he  will  be  virtuous  he  will  be  happy,  or 
words  to  that  eflfect.  Small  wonder  then  that, 
after  a  moment's  attention,  his  thoughts  wander, 
and  he  drifts  away  on  that  beautiful  river  of 
revery  upon  whose  banks  are  Spanish  castles 
unmatched  by  those  of  the  Rhine  or  the 
Danube,  and  which  are  in  strange  contrast  to 
the  practical,  prosaic,  warehouse  sort  of  view 
which  his  orator  is  trying  to  present.  If, 
therefore,  I  observe  five  minutes  hence  that 
some  of  ray  special  audience  here,  the  new 
graduates,  are  gazing  reflectively  upon  some 
point  of  infinite  distance,  or  are  evidently 
magnetized  by  some  particular  wave  in  the  sea 
of  this  other  audience  before  me,  I  shall  know 
that  it  is  all  quite  as  it  should  be,  and  that  my 
remarks  are  fulfilling  their  purpose. 

Being  unable,  as  I  have  just  explained,  to 
remember  what  was  said  to  me  by  way  of 
valedictory,  and  never  having  been  present  at 
a  similar  ceremony  from  that  day  to  this,  I 
thought  it  would  be  prudent  to  consult  the 
literature  of  the  subject  and  find  out  what  is 
usually  said  upon  such  occasions.  For  this 
purpose  I  have  examined  about  a  hundred 
valedictory  addresses,  and  have  obtained  from 
them  a  vast  amount  of  instruction,  and  some 
little  amusement.  From  them  I  gather  that 
this  is  an  epoch  in  your  lives,  that  you  are 
entering  a  remarkable  age  of  the  world's  his- 
tory (it  is  customary  here  to  allude  to  steam 
and  electricity),  that  you  live  in  the  most 
wonderful  country  under  the  sun,  and  that  the 
eves  of  the  world  are  upon  you.  All  are 
agreed  upon  these  points,  and  also  as  to  the 
impoitance  and  dignity  of  the  science  and  art 
of  medicine,  and  the  necessity  of  continued 
study  on  your  part  to  keep  pace  with  its 
advances.  But  the  addresses  are  not  equally 
harmonious  on  all  points.  Some  of  them  assert 
that  the  condition  of  medical  education  in  this 
country  is  not  altogether  satisfactory,  that  there 
are  some  medical  colleges  (not,  of  course,  the 


138 


CANADIAN  JOURNAL 


college  of  the  graduates,  but  some  other  medical 
college)  which  might  be  spared,  and  that  some 
of  these  not  only  have  not  as  clear  ideas  about 
the  precession  of  the  equinoxes,  or  the  author- 
ship of  the  book  of  Job,  as  a  member  of  one  of 
the  learned  professions  should  have,  but  that 
there  are  even  graduates  in  medicine  (of  other 
schools  of  course),  to  whom  the  addition  of 
vulgar  fractions  is  a  stumbling-block,  and  cor- 
rect spelling  vexation  of  spirit.  On  the  other 
hand  I  find  some  who  assert,  first,  that  the 
above  statements  are  unfounded ;  second,  that 
it  is  not  necessary  to  know  how  lo  gpell  cor- 
rectly in  order  to  cure  the  chills  or  set  a  broken 
leg;  and  third,  that  the  demand  for  higher 
medical  education  is  essentially  a  pernicious 
aristocratic  movement,  calculated  to  oppress 
the  poor,  and  prevent  them  from  obtaining  the 
sheepskins  so  desirable  to  cover  their  naked- 
ness. As,  however,  I  am  sure  that  all  of  you 
are  just  now  strongly  in  favour  of  higher 
medical  education,  without  regard  to  what  you 
may  have  thought  about  it  a  few  weeks  ago,  or 
what  you  may  think  of  it  a  few  years  hence, 
when  you  get  a  little  sfceam-hatching  machine 
of  your  own,  I  feel  that  I  shall  most  contribute 
to  the  harmony  which  this  case  demands  by — 
entirely  agreeing  with  you. 

U[)on  the  whole,  I  came  to  the  cDnclusion 
that  on  this  occasion  it  is  safest  to  talk  plati- 
tudes; in  fact,  I  must  do  this  if  I  am  to  advise 
you  as  a  body.  The  inexorable  laws  of  statistics 
tell  me  that  among  you  are  those  having  the 
most  diverse  capacities,  purposes,  and  destina- 
tions. Two  or  three  of  you  will  go  on  with 
your  studies  for  the  next  ten  or  fifteen  years, 
observing,  experimenting,  reading,  and  com- 
paring, until  some  fine  day  you  will  know 
something  that  other  people  don't  know,  and 
will  become  writers  and  teachers,  leaders  in 
your  profession,  famous  in  your  day  and  gener- 
ation. One  or  two  of  jou  may  become  popular 
physicians,  for  whom  being  called  in  consulta 
tion  is  an  everyday  matter,  and  a  large  income 
a  matter  of  course.  Many  of  you  will  become 
plain,  solid,  common-sense  practitioners,  who 
will  do  a  vast  amount  of  good,  be  indispensable 
to  the  comfort  and  safety  of  the  community, 
and  be  happy  because  satisfied,  which  is  more 
than  I  can  predict  of  the  others.     A  few  will 


abandon  medicine  because  it  does  not  pay,  and 
turn  to  some  occupation  of  better  promise. 
And  one  or  two  will  slip  farther  and  faster 
down  the  broad,  smooth  path  of  dissipation  on 
which  their  feet  have  already  taken  the  first 
step,  and  will  pass  on  to  the  inevitable  end. 

Fortunately  for  all  of  us,  nobody  knows  who 
are  to  be  the  black  sheep  and  who  are  to  win 
the  prizes.  Ench  of  you  must  live  out  that 
which  is  in  your  brains  and  blood,  the  result  of 
generations  gone  before ;  but,  you  have  also  to 
live  out  that  which  you  yourselves  add  to  the 
inheritance. 

Now  you  are  going  out  into  Vanity  Fair 
duly  armed  and  equipped,  and  provided  with 
maps  and  guide-books  of  the  latest  and  most 
approved  editions.  Probably  you  will  never 
again  be  so  fully  conscious  of,  or  so  thoroughly 
satisfied  with,  your  knowledge  of  the  science 
and  art  of  medicine  as  you  are  to-night.  What 
would  I  not  give  now  to  know  as  much  as  I 
thought  I  knew  the  day  I  received  my  diploma. 
And  yet  the  seven  world  problems  of  Du  Bois- 
Raymond  are  still  unsolved. 

I  congratulate  you  on  your  prospects.  Shall 
J  tell  you  what  some  of  them  are  1  Our 
American  life  will  present  to  you  as  much 
variety,  as  vivid  contrasts,  as  subtle  mysteries, 
and  as  many  giants,  demons,  and  sirens  to  be 
overcome  or  outwitted  as  any  that  the  legends 
of  old  depict.  No  doubt  you  will  soon  come 
across  some  of  that  curious  sect,  the  antis,  who 
are  beginning  to  make  their  appearance  amongst 
us ;  anti-vaccinationists,  anti-vivisectionists, 
an ti-any thing,  so  that  it  gives  them  an  excuse 
to  keep  their  names  before  the  public.  And 
when  you  are  asked  how  you  account  for  the 
voluminous  statistics  and  startling  facts  which 
some  of  these  antis  produce  so  rapidly  and 
easily,  you  may  hesitate  a  little,  unless  you 
have  heard  the  celebrated  conundrum  which  I 
am  about  to  give  you.  A  little  boy  said, 
"  That  girl  is  the  daughter  of  my  father  and 
my  mother,  but  she  is  not  my  sister.  How  do 
you  account  for  that  ? "  And  the  answer  is, 
(this  is  strictly  confidential),  that  the  little  boy 
lied.  Taking  them  all  in  all,  these  antis  are  a 
curious  class  of  cranks,  worthy  of  careful  study 
on  the  part  of  some  of  our  experts  in  mental 
diseases,  during  the   brief  intervals  in  which 


OF  MEDICAL  SCIENCE. 


139 


they  have  no  medico-legal  case  on  hand.  Some 
of  them  are  quite  honest  in  their  convictions, 
and  all  are  very  theological  and  emotional  in 
their  appeals,  and  to  this  they  owe  what  success 
they  have  in  achieving  notoriety  ;  and  yet, 
while  professing  the  most  humane  sentiments, 
they  are  unscrupulous  even  to  cruelty  in  carry- 
ing out  their  fantastic  ideas.  Tbey  will  not 
greet  your  coming  on  the  stage  of  action  with 
any  particular  enthusiasm,  but  you  must  not 
be  discouraged  on  that  account. 

You  will  find,  also,  that  the  manufacturing 
pharmacist  is  abroad  in  the  land,  and  that  he, 
on  the  other  hand,  will  be  very  glad  to  make 
your  acquaintance.  He  will  not  only  supply 
you  with  toothsome  preparations,  neatly  put 
up  in  artistic  packages,  but  he  will  tell  you 
what  they  are  good  for,  in  what  doses  to  use 
them,  and,  most  important  of  all,  which  of 
them  are  in  accordance  with  the  code  of  ethics. 
He  will  ornament  your  office  with  innumerable 
samples,  and  pleasantly  interrupt  and  variegate 
the  perusal  of  your  medical  journals  by  means 
of  blue,  green,  and  yellow  advertising  sheets, 
unexpectedly  and  neatly  inserted.  Under  his 
friendly  guidance  the  path  of  medicine  becomes 
a  flowery  one,  for  all  that  you  have  to  do  is  to 
decide  upon  the  name  of  the  disease  of  your 
patient,  and  then  look  over  the  advertisements 
and  samples  to  see  what  will  cure  it. 

Moreover,  there  are  some  canvassers,  and 
publishers,  and  editors,  who  are  prepared  to  be 
your  best  friends  if  you  will  only  permit  it. 
'  They  want  you  in  the  first  place  to  subscribe, 
and  then  to  write ;  to  produce  from  the  stores 
of  your  knowledge,  items,  and  essays,  and 
papers,  to  help  them  to  raise  the  standard  of 
American  medical  literature,  until  it  shall  be 
high  above  that  of  the  efiete  despotisms  of 
Europe.  Nor  are  these  the  only  persons  thh,t 
await  your  coming.  You  are  wanted  in  Med- 
ical Societies,  the  advocates  of  higher  medical 
education  rely  on  your  support,  Boards  of 
Health  and  Registrars  are  looking  to  you  to 
make  their  statistics  perfect  and  complete,  and 
Army  and  Navy  Medical  Examining  Boards 
are  preparing  fresh  lists  of  questions  for  your 
benefit.  But  perhaps  you  flatter  yourselves 
that  you  have  now  passed  your  final  examina- 
tion.     Never   was  a  greater  mistake.     Your 


most  severe  and  continued  ordeal  is  just  about 
to  begin.  And  it  may  be' that  the  result  will 
give  rise  in  some  of  your  minds  to  serious 
doubts  as  to  the  value  of  the  Darwinian  theory 
about  the  survival  of  the  fittest.  But  at  all 
events  I  can  assure  you  that  you  need  have  no 
fear  as  to  there  not  being  room  for  you,  or  that 
the  world  has  not  work  enough  for  you  to  do. 
You  know  the  old  saying,  "There  is  always 
plenty  of  room  on  top."  But  even  in  the 
lower  stories  their  is  plenty  of  standing  room. 
There  are  to-day  between  one  and  two  millions 
of  sick  people  in  the  United  States,  and  the 
deaths  for  this  year  will  certainly  be  a  million. 
You  see,  therefore,  that  the  sanitarians,  whom 
some  of  you  may,  unwisely,  look  upon  as 
enemies,  since  they  are  trying  to  do  away  with 
some  of  the  causes  which  necessitate  your 
services,  have,  at  all  events^  not  yet  seriously 
injured  the  business  of  the  profession.  And 
for  your  further  encouragement  I  will  predict 
that  it  will  be  a  long  time  before  they  succeed 
in  doing  this,  for  whatever  variations  the 
changing  seasons  bring  to  our  other  harvests, 
the  fool  crop  continues  with  almost  unvarying 
regularity. 

While  I  am  on  this  subject,  however,  let  me 
advise  you  from  the  business  point  of  view,  as 
well  as  on  account  of  your  interests  as  citizens 
and  humanitarians,  to  look  into  this  matter  of 
preventive  medicine  a  little  more  closely  than 
you  have  yet  probably  had  time  to  do.  It  is 
going  to  be  a  very  important  matter  in  your 
day  and  generation,  and  you  will  be  examined 
and  cross-questioned  on  it  to  an  extent  which 
yon  little  suspect.  Some  of  you  will  no  doubt 
be  called  to  act  as  members  of  Boards  of 
Health,  and  all  of  you  are  sure  to  be  appealed 
to  on  questions  of  ventilation,  house  drainage, 
school  -hygiene,  pure  water,  adulterated  food 
and  drugs,  and  the  means  of  shunning  or  put- 
ting away  the  pestilences,  which  will  consume 
not  only  the  children  of  other  people,  but  your 
own  also,  if  you  cannot  answer  the  sphinx'g 
riddle. 

You  will  find  that  public  health  legislation 
is  a  matter  to.which  you  cannot  remain  indif- 
ferent, for  you  will  become  part  of  the 
machinery  whether  you  wish  to  or  not,  and  if 
you  are  wise  you  will  study  the  subject  so  that 


140 


CANADIAN  JOURNAL 


you  can  aid  in  shaping  this  legislation  to  what 
it  sh'  uld  be,  for  in  this  respect  knowledge  is 
power.  If  you  leave  the  matter  to  sentimental 
enthusaists  and  professional  office-seekers,  you 
will  find  that  it  will  turn  out  like  the  Irish- 
man's ale — it  will  thicken  as  it  clears.  One  of 
the  matters  just  alluded  to  touches  your  profes- 
sional work  very  nearly,  and  that  is  the  adul- 
teration of  drugs.  If  you  practice  in  a  large 
city,  this  is  not  of  so  much  importance,  since 
you  can  always  readily  find  first-class  phar- 
macists, upon  whose  preparations  you  can  rely, 
but  away  from  the  great  centres,  the  case  is 
different.  Unless  you  can  depend  upon  getting 
what  you  call  for  in  your  prescription,  what 
success  can  you  hope  for  1  and  yet  unless  you 
know  what  apothecary  is  to  fill  that  prescrip- 
tion you  cannot  rely  upon  it.  And  it  is  always 
wise  not  to  conclude  that  your  treatment  has 
failed  until  you  have  made  sure  that  what  you 
have  ordered  has  really  been  given. 

And  in  this  immediate  connection,  permit 
me  to  remind  you  why  the  hyrax  has  no  tail. 
It  is  written  in  the  mystic  volume  of  St. 
Nichola*  that  when  the  world  was  about  being 
completed,  notice  was  issued  to  all  the  beasts 
that,  if  they  would  go  to  the  Court  of  the  King 
on  a  certain  day,  they  would  be  handsomely 
finished  off  with  tails.  All  were  pleased  with 
the  prospect,  but  the  hyrax  was  especially  de- 
lighted. Now  when  the  appointed  day  came, 
it  was  cold  and  rainy,  and  the  hyrax  did  not 
like  to  go  out  in  bad  weather.  So  he  stood  in 
his  door  and  asked  the  lion  and  the  wolf  and 
several  others  to  bring  him  his  tail,  and  they 
all  promised  to  attend  to  it.  But  they  all  for- 
got it ;  and  when  the  hyrax  went  himself  the 
next  day  to  see  about  it,  he  found  that  the 
supply  of  tails  was  exhausted.  That  is  why 
the  hyrax  has  no  tail,  and  if  you  rely  on  what 
other  people  tell  you  what  they  have  done,  or 
are  going  to  do  for  you,  the  result  will  pro- 
bably be  about  the  same. 

And  just  here  permit  me  to  give  you  an 
entirely  new  bit  of  advice  ;  at  least,  I  did  not 
find  it  in  any  of  the  valedictories  I  read.  You 
will,  of  course,  never  ask  a  man  who  is  not 
acquainted  with  you  personally  to  give  you 
recommendations  or  testimonials  ;  but  see  to  it 
that  you  yourselves  never  sign  a  recommenda- 


tion for  a  man  whom  you  do  not  know.  Do  not 
be  persuaded  or  bullied  into  doing  this  by  peo- 
ple whom  you  know,  for  people  whom  they 
know,  -but  you  do  not.  If  you  wish  your  name 
and  opinion  to  have  any  value  in  the  eyes  of 
other  people,  respect  them  yourself. 

Do  not  be  in  a  hurry  to  write  or  teach.  The 
American  press  has  been  said  to  be  chronically 
premature,  and  the  same  may  be  said  of  a  good 
many  graduates — not,  of  course,  of  this  school, 
but  of  some  other  schools ;  and  not  only  in 
this  country,  but  in  other  countries.  There  are 
a  great  number  of  men,  in  all  professions,  and 
in  all  parts  of  the  world,  of  whom  it  may  be 
truly  said,  that  if  they  knew  more  they  would 
say  les«.  Try  to  know  something  of  all 
branches  of  science,  for  they  all  throw  light 
upon  your  work ;  and  at  the  same  time  try  in 
some  one  branch  of  your  own  special  field  of 
study  to  know  more  than  anybody  else,  and  to 
be  sure  that  you  really  do  know  it.  This  is 
not  so  difficult  as  it  may  seem.  You  will  not 
have  to  go  far  in  any  direction  before  you  will 
come  upon  that  which  is  doubtful  or  unknown 
— questions  which  as  yet  have  no  answers. 
And  if,  during  your  pupilage, you  have  learnedto 
think,  and  are  not,  as  Holmes  phrases  it,  merely 
"  phonographs  on  legs,"  the  rest  is  a  mere 
matter  of  detail,  and  this  advice  is  not  difficult 
to  follow.  Hesiod  said  that  in  his  day  there 
were  three  kinds  of  men — those  who  understand 
things  of  themselves,  those  who  undei-stand 
things  when  they  are  explained  to  them,  and 
those  who  neither  understand  things  of  them-, 
selves  nor  when  they  are  explained  to  them. 
That  was  the  classification  in  Greece  over  two 
thousand  years  ago,  but  it  is  a  convenient  one 
for  use  even  now ;  and  when  a  man  has  settled 
for  himself  to  which  class  he  belongs,  his  edu- 
cation has  taken  a  long  stride. 

Each  of  you  has  his  aspirations — a  little 
vague,  no  doubt,  but  none  the  less  real.  Keep 
them  as  long  as  possible,  and  above  all  things, 
do  not  assume  or  affect  a  cynieism  which 
belongs  neither  to  your  age  nor  to  your  ex- 
perience. Second-hand  misanthropy  is  like  a 
second-hand  Chatham  Street  coat :  it  never  fits. 
No  doubt  you  all  desire  to  make  money ;  not 
for  the  money's  sake,  but  for  what  you  can 
do  with  it.     It  is  not  a  desire  to  be  ashamed 


OF  MEDICAL  SCIENCE. 


141 


of,  and  the  business  of  your  profession  de- 
mands your  careful  attention.  But  mark  this  : 
The  best  works  in  the  world  are  not  done  for 
money,  or  from  selfish  motives  of  any  kind. 
And  if  you  are  to  achieve  true  success — the 
success  which  brings  happiness,  and  is  the 
only  kind  worth  seeking — you  must  do  a  vast 
amount  of  work,  not  for  money,  but  in  part 
because  you  like  it,  and  in  part  because  it 
will  do  good  and  help  others.  Do  not  wait 
for  the  opportunity  to  do  some  great  thing. 
Take  hold  of  the  work  that  lies  next  your 
hand ;  work  which  you  can  do,  and  which 
ought  to  be  done — it  will  be  very  strange  if 
there  is  not  always  something  of  that  sort 
waiting  for  you ;  and  do  not  dawdle,  and 
defer,  and  lose  the  good,  in  a  vain  waiting 
and  longing  for  the  best. 

Be  healthy,  brave-hearted,  and  joyous.  Phy- 
sical health  is  unfortunately  not  contagious, 
but  mental  and  moral  health  is.  Avoid 
second-hand  philosophy,  sickly  complainings 
about  the  evils  and  miseries  of  life,  and  small 
beer  of  all  kinds.  No  doubt  you  will  find 
many  of  your  golden  dreams  fading  into  gray 
mists  ;  but,  on  the  other  hand,  you  will  be 
continually  stumbling  against  solid  realities, 
which  are  quite  as  good  as  any  dreams  if  you 
only  recognize  the  opportunity.  Labor  and 
trouble  you  must  meet ;  but  of  the  first  you 
can  for  the  most  part  make  a  pleasure,  and ' 
the  second  should  not  be  pampered  and  made 
a  luxury  of.  Never  pity  yourselves.  Do  not 
waste  your  time  in  vain  speculations  as 
to  the  why.  Remember  that  bitter  little 
poem  of  Heine's : 

*'  By  the  sea,  by  the  dreary  darkening  sea,  stands  a 

youthful  man, 
His  head  all  questioning,  his  heart  all  doubting, 
And  with  gloomiest  accent  he  questions  the  billows. 
Oh,  solve  me  life's  riddle,  I  pray  ye,  the  torturing 

ancient  enigma 
O'er  which  full  many  a  brain  hath  long  puzzled.  .  .  . 
Tell    me,   what  signifies   man  ?     Whence   came   he 

hither  ? 

Where  goes  he  hence  ? .  .  .  . 

"The  billows  are  murmuring  their  murmur  unceasing. 
Wild  blows  the  wind,  the  dark  clouds  are  fleeting, 
The  stars  are  still  gleaming  so  calmly  and  cold, 
And  a  fool  is  awaiting  an  answer." 

In    the  majority   of    valedictory   addresses 


which  I  have  examined,  there  was  a  more  or 
less  special  advice  about  medical  ethics,  and  a 
word  or  two  on  this  subject  is,  therefore,  not 
out  of  place.  The  code — or,  perhaps,  I  should 
now  rather  say  the  codes — of  medical  ethics 
are  great  mysteries  to  the  public  at  large.  By 
many  it  is  supposed  to  be  a  sort  of  trades-union 
set  of  rules  designed  to  protect  the  business 
interests  of  physicians,  without  any  particular 
regard  to  the  rest  of  the  world.  I  need  hardly 
say  to  you  that  this  is  not  true.  It  may  be 
summed  up  in  this,  that  a  physician  should  be 
a  gentleman,  and  should  treat  other  physicians 
and  his  patients  as  he  would  wish  to  be  treated 
under  like  circumstances.  And  your  duty  in 
this  matter  is  to  attend  to  your  own  ethics  and 
not  those  of  other  people.  Medicine  is  not  a 
rigid  system  of  rules  and  formulae  as  it  was  in 
ancient  Egypt ;  a  fixed  creed  to  which  you  are 
to  subscribe,  and  from  which  you  must  not 
vary.  It  is  a  living,  growing  t'  ing,  making 
use  of  every  resource  which  the  progress  of 
science  brings  ;  it  is  truly  eclectic  and  catholic 
testing  all  things,  and  holding  fast  to  that 
which  is  good.  It  is  not  a  system  which 
forbids  the  use  of  any  particular  remedy,  or 
limits  its  followers  within  the  narrow  bounds 
of  sect  or  ism.  There  are  such  systems,  and 
there  are  a  few  men  who  advertise  themselves 
as  followers^  of  such  systems,  and  who  really  do 
follow  them.  There  are  also  many  men  who 
so  advertise,  but  who  really  do  not  follow 
them.  Some  of  these  last  are  well-educated 
physicians,  "  but  they  are — that  is  to  say 
from  the  point  of  view  of  a  gentleman,  they 
must  be  considered  as — in  short,  the  more 
you  know  of  their  methods  the  more  fervidly 
you  will  assent  to  what  I  have  not  said  about 
them." 

One  of  the  latest  authoritative  expressions 
of  opinion  on  this  subject  is  the  following  reso- 
lution recently  adopted  by  the  Koyal  College 
of  Physicians  in  London  : 

"  While  the  College  has  no  desire  to  fetter 
the  opinion  of  its  members  in  reference  to  any 
theories  they  may  see  fit  to  adopt  in  connection 
with  the  practice  of  medicine,  it  nevertheless 
expresses  its  opinion  that  the  assumption  or 
acceptance  by  members  of  the  profession  of 
resignations  implying  the  adoption  of  special 


142 


CANADIAN  JOURNAL 


modes  of  treatment  is  opposed  to  those  princi- 
ples of  the  freedom  and  dignity  of  the  profes- 
sion which  should  govern  the  relations  of  its 
members  to  each  other  and  to  the  public.  The 
College,  therefore,  expects  that  all  its  fellows, 
members,  and  licentiates  will  uphold  these 
principles  by  discountenancing  those  who  trade 
upon  such  designations."  This  last  sentence 
touches  the  root  of  the  difficulty.  Those  who 
trade  upon  such  designations.  Let  us  take  a 
concrete  example.  You  treat  a  case  of 
pemphigus  with  arsenic.  You  may  theorize 
as  you  like  about  the  essential  nature  of 
pemphigus ;  you  may  select  arsenic  because 
you  think  it  would  produce  the  disease,  or 
because  you  think  it  produces  something 
contrary  to  the  disease,  or  for  no  reason 
whatever  beyond  the  empirical  fact  that  you 
have  seen  a  case  of  pemphigus  recover  under 
the  use  of  arsenic.  Also,  you  may  give  this 
arsenic  alone  or  combined  with  other  sub- 
stances, and  in  any  doses  that  you  please,  from 
the  decillionth  of  a  grain  to  a  grain,  and  you 
may  explain  the  results  as  you  like.  But  as 
an  educated  physician,  and  a  gentleman,  you 
may  not  advertise  yourself  as  an  arsenio  pem- 
phigist,  and  denounce  every  one  who  does  not 
adopt  your  theory  and  practice,  and  as  there  is 
a  good  deal  of  common-sense  truth  in  the  old 
adage,  that  a  man  may  be  known  by  the  com- 
pany he  keeps,  you  will  not  have  more  to  do 
than  you  can  help  with  the  men  who  do  so 
advertise  themselves ;  and  still  less  will  you 
have  to  do  with  those  who  advertise  themselves 
as  antiarsenio^pemphigists,  and  then  treat  their 
cases  with  arsenic  after  all,  and  claim  the  re- 
sults as  due  to  dynamized  brickdust. 

And  please  observe  that  this  is  all  that  you 
have  to  do.  You  are  not  to  enter  into  con- 
troversies with  them  or  abuse  them,  you  are 
not  to  repine  over  their  success  or  exult  over 
their  failures.  They  have  another  code  of 
ethics  from  your  own  ;  that  is  all  that  need  be 
said  about  it.  Thus  far  I  have  been  speaking 
of  fairly  educated  sectarian  physicians.  As  to 
the  ordinary,  uneducated,  and  bill-distributing 
quack,  with  his  sure  cure  for  cancer,  or  his  pure 
vegetable  specific  for  coughs,  rheumatism,  and 
dyspepsia,  you  may  be  sure  that  in  the  long 
run  he  will  make  rather  more  business  for  you 


than  he  takes  away.  Do  not  fall  into  the  error 
of  supposing  that  h'gislation  can  prevent  the 
eicistence  of  this  class  of  men,  or  that  you  need 
the  protection  of  the  law  against  them.  The 
public  interest  demands  such  protection,  if  for 
no  other  reason  than  to  secure  a  proper  regis- 
tration of  the  causes  of  deaths  of  all  citizens, 
and  it  is  not  only  your  right,  but  your  duty, 
to  call  the  attention  of  legislators  to  these  in- 
terests, but  never  seek  protection  on  your  own 
account. 

Be  honest  to  yourselves  as  well  as  to  other 
people,  and  do  not  be  afraid  of  admitting  that 
yon  do  not  know,  or  feel  bound  to  attempt  an 
explanation  of  all  that  you  see  or  do.  He  who 
would  know  anything  thoroughly  must  be  con- 
tent to  be  igi"orant  of  many  things.  Try  to 
define  to  yourself,  as  clearly  as  possible, your  own 
ignorance ;  it  is  the  first  step  towards  remedy- 
ing it,  and  be  sure  that  the  modest  student, 
whether  he  be  under-graduate  or  learned  pro- 
fessor, will  everywhere  meet  with  helping 
hands  in  the  great  brotherhood  of  science. 

There  are  many  men  who  are  honest  in  pur- 
pose, and  yet  who  are  constantly,  although  not 
consciously,  untruthful ;  they  see  that  which 
they  think  they  ought  to  see,  and  not  that 
which  is. 

I  am  reminded  that  this  is  a  valedictory  ad- 
dress, and  that  in  it  I  must  bid  you  farewell. 
This  I  do  in  behalf  of  your  teachers,  whose  un- 
availing regrets  that  they  are  not  to  have 
another  opportunity  of  meeting  you  in  the 
examination-room,  you  can  imagine  much  better 
than  I  can  describe.  What  they  could  do  for 
you  they  have  done.  And  now,  as  Emerson 
says,  "We  have  accompanied  you  with  sym- 
pathy, and  manifold  old  sayings  of  the  wise,  to 
the  gate  of  the  arena,  but  'tis  certain  that  not 
by  strength  of  ours,  or  of  the  old  sayings,  but 
only  on  strength  of  your  own,  unknown  to  us 
or  to  any,  you  must  stand  or  fall."  You  may 
be  sure  of  our  best  wishes  for  your  success  and 
happiness. 

"  Who  misses  or  who  wins  the  prize,  go  lose  or  con- 
quer  as  you  can  ; 
But  if  you  fall  or  if  you  rise,  be  each,  pray  God, 
a  gentleman." 

But  while  I  bid  you  farewell  as  students,  I 
also  bid  you  welcome  to  the  ranks  of  the  pro- 


OF  MEDICAL  SCIENCE. 


143 


fession.  And  I  can  asure  yon,  that  upon  the 
whole,  you  are  coming  into  very  good  company. 
If  in  anything  I  have  said  this  evening  I  have 
seemed  to  speak  lightly  of  the  medical  profession 
or  its  adjuncts,  I  hope  it  will  not  be  construed 
as  more  than  the  ordinary  banter  in  which  we 
boys  sometimes  indulge  when  we  get  off  in  a 
quiet  corner  by  ourselves, 

I  have  much  faith  in  the  advice  of  that 
anonymous  writer  who  said  : — 

' '  Oh,  never  wear  a  brow  of  care,  or  frown  with  rueful 
gravity, 
For  wit's  the  child  of  wisdom,  and  good  humor  is  the 
twin. 
No  need  to  play  the  Pharisee,  or  groan  at  man's 
depravity  ; 
Let  one  man  be  a  good  man,  and  let  all  be  fair  within. 
Speak  sober  truths  with  smiling  lips  ;  the  bitter  wrap 
in  sweetness, 
Sound  sense  in  seeming  nonsense,  as  the  grain  is  hid 
in  chaff. 
And  fear  not  that  the  lesson  e'er  may  seem  to  lack 
completeness, 
A  man  may  say  a  wise  thing,  though  he  say  it  with  a 
laugh." 

It  is  true  that  you  are  entering,  nay,  in  your 
medical  studies  you  have  already  entered,  a 
world  of  labor,  and  pain,  and  sorrow.  You 
will  see  how  the  destruction  of  the  poor  is  their 
poverty,  and  how  the  sins  of  the  fathers  are 
visited  upon  the  children  ;  how  neither  culture, 
nor  wealth,  nor  power,  can  forever  put  off  the 
evil  day  ;  and  how  there  is,  at  last,  one  event 
to  all  the  sons  of  men. 

You  must  be  prepared  to  deal  with  anxiety, 
fear,  grief,  and  despair,  as  well  as  fever  and 
physical  pain  ;  you  are  to  be  not  only  physician, 
but  friend,  confessor,  guide,  and  judge,  and  you 
cannot  avoid  these  responsibilities  if  you  would, 
nor  should  you  if  you  could. 

Nevertheless,  I  can  assure  that  you  are  also 
entering  a  beautiful  world,  where  the  very 
shadows  prove  that  plenty  of  sunshine  exists, 
a  world  of  brave  men  and  good  women,  whose 
best  and  noblest  characteristics  are  brought  out 
most  clearly  and  vividly  in  such  scenes  as  those 
in  which  you  will  be  called  to  act.  But  remem- 
ber, that  as  a  rule,  you  will  find  only  what  you 
seek  and  believe  in.  Remember,  also,  that  this 
knowledge  which  you  have  acquired,  and  aie 
yet  to  acquire,  is  entrusted  to  you  as  a  power, 


a  power  none  the  less  real,  and  involving  no 
less  responsibility  because  it  is  accompanied 
by  no  special  outward  insignia  of  authority  or 
rank. 

By  the  help  of  this  knowledge  you  are  to  get 
wisdom — that  wisdom  which  always  lingers, 
and  sometimes  comes  too  late ;  that  wisdom  of 
which  it  is  written  that  for  all  the  children  of 
men  "length  of  days  are  in  her  right  hand,  and 
in  her  left  hand  riches  and  honor." 

The  New  Yori^  State  Medical  Society, 
when  it  enacted  its  little  law  permitting  con- 
sultations with  all  legally  qualified  practition 
ers,  viz.  :  homceopaths,  eclectics,  and  the  horde 
of  irregular  practitioners,  had  but  eighty  mem- 
bers present ;  and  there  was  of  these  a  good 
minority  (30)  opposed  to  such  action.  There 
are  over  4,500  qualified  regular  practitioners  in 
this  State.  It  remains  to  be  seen,  whether  a 
small  collection  of  fifty  doctors  are  to  so  over- 
ride the  views  and  defy  the  convictions  and 
customs  of  this  great  medical  army,  as  to  bring 
all  reputable  practitioners  of  the  State  into 
absolute  collision  with  the  American  Medical 
Association  ;  and  to  place  them  in  opposition 
to  the  recognized  views  and  respected  customs 
of  the  60,000  reputable  physicians  of  this 
country.  It  is  certain  that  59,950  physicians 
of  the  United  States  are  justly  opposed  to  any 
such  consultations  ;  wherein  there  can  not  be 
either  honourable  agreement  or  rational  com- 
promise. And  if  a  small  majority  of  a  small 
body  of  eighty  men  are  to  control  and  defy  the 
impregnable  sentiment  of  over  59,U00  physi- 
cians, the  day  of  absolute  absurdity  and  medi- 
cal chaos  has  fully  and  fatally  dawned.  The 
American  Medical  Association  will,  of  course, 
justly  repudiate  the  New  York  Medical  Society, 
and  all  who  yield  an  allegiance  to  its  recent 
inexcusable  legislation.  And  the  best  medical 
men  everywhere,  will  say  Amen,  and  Amen. 
— American  Medical  Weekly. 


New  Source  op  Vaccine  Virus. — A  new 
source  of  vaccine  virus  has  recently  been  dis- 
covered in  France,  according  to  the  Progrea 
Mhdical.  A  cow  was  recently  discovered  at 
Eus}res,  in  the  vicinity  of  Bordeaux,  nffected 
with  the  vaccine  disease  spontaneously  devel- 


U4 


CANADIAN  JOITHNAL  OK  MEDICAL  SCIENCE. 


oped.  From  the  virus  thus  obtained  a  heifer 
was  inoculated,  and  sent  to  Paris.  An  exam- 
ination by  the  members  of  the  Academy  took 
place,  at  which  it  was  shown  that  about  thirty 
genuine  pustules  were  located  in  the  vicinity 
of  the  teats.  The  virus  taken  trom  these 
pustules  produced  other  pustules  on  children 
heifers  exacdy  identical  with  those  of  normal 
vaccine.  From  the  vaccine  virus  thus  ob- 
tained, M.  Chambon,  from  whose  stables  the 
hospitals  of  Paris  are  supplied,  has  renewed 
his  animal  vaccine.  He  now  favours  the  pro- 
pagation of  this,  called  the  Gironde,  vaccine  in 
the  city.  The  virus  is  considered  equal  to  the 
most  renowned,  that  of  Passy,  discovered  in 
1836,  and  that  of  Beaugency,  obtained  in  1866. 
— Pittsburgh  Medical  Journal,  March,  1882. 


The  Ethics  of  New  York. — The  proposi- 
tion of  the  society  of  the  State  of  New  York, 
to  hold  consultations  with  all  legally-qualified 
practitioners  of  medicine,  does  not  exclude  the 
licensed  cancer  quack,  the  midwife,  and  the 
chiropodist.  It  embraces  all  the  pathies. 
Now,  this  is  called  ethics,  and  we  are  plainly 
informed  by  the  Record  that  this  is  reform. 
Fortunately,  the'  provisions  for  enforcing  this 
code  of  defiance  to  all  ethics  and  common 
decency  are  limited  to  the  prostitutes  of  pro- 
fessional morals,  and  the  country  may  yet  be 
saved. — Louisville  Medical  Herald. 


The  Boston  Medical  and.  Surgical  Journal, 
says  :  "  Lentree  est  defendue  aux  dames  "  is 
certainly  not  a  suitable  inscription  to  be  placed 
over  the  portals  of  a  University ;  and  it  is 
satisfactory  to  be  assured  by  tlie  President  of 
the  Boston  University,  in  his  last  report,  that 
a  phrase  so  often  seen  over  certain  apartments 
in  French  railway  stations  will  be  denied  a 
place  upon  the  front  of  the  University  building. 
— Phila.  Med.  and  Surg.  Journal. 


Dr.  Thomas  K.  Chambers  has  been  elected 
to  represent  Oxford  University  in  the  General 
Council  of  Medical  Education  and  Registration 
in  the  United  Kingdom  for  five  years,  in  place 
of  the  late  Professor  Ilolleston. 


(Dbituary. 


JOSEPH  PANCOAST,  M.D. 
This  distinguished  and  venerable  surgeon 
died  in  Philadelphia  on  the  7th  ult.,  from  a 
pneumonic  influenza,  at  the  advanced  age  of 
76.  He  was  bom  in  Burlington  Co.,  N.  J., 
in  November,  1805,  graduated  in  medicine 
from  the  University  of  Pennsylvania  in  1828, 
and  practised  in  Philadelphia  from  first  to 
last.  He  succeeded  Dr.  Geo.  McClellan  in  the 
Chair  of  Surgery  at  Jefferson  Medical  College, 
in  1838,  and  held  this  position  until  the  recon- 
struction of  the  school  in  1811,  when  he  was 
transferred  to  the  Chair  of  Anatomy,  which  he 
continued  to  occupy  with  great  acceptance  and 
distinction  until  his  resignation  in  1874  when 
he  was  elected  emeritus  professor.  During  his 
career  he  was  connected  with  several  of  the 
Philadelphia  hospitals.  He  translated  Lob- 
stein's  "  Treatise  on  the  Sympathetic  Nerve"  in 
1831,  and  was  editor  of  "  Manec  on  the  Sympa- 
thetic" and  on  the  "  Cerebrospinal  System  in 
Man,"  of  Wistar's  "Anatomy,"  and  of  Quain's 
"Anatomical  Plates, "  and  he  publish  ed  a  "Treatise 
on  Operative  Surgery"  in  1844.  As  an  oper- 
ator he  was  bold,  brilliant,  original,  and  suc- 
cessful ;  as  a  teacher  learned,  lucid,  influential, 
and,  above  all,  practical.  He  has  left  an  im- 
press in  the  history  of  American  surgery  which 
time  will  not  readily  efface. 


MARBIAOES. 

On  Febraary  23rd,  at  Christ  Chiirch,  Brampton,  by 
the  Rev.  C.  C.  Johnston,  R.  S.  Tyrrell,  Esq.,  M.D.,  of 
Toronto,  to  Grace,  eldest  daughter  of  Dr.  N.  0.  Walker, 
of  Port  Dover. 

At  "  Bassington,"  township  of  Craniahe,  on  the  8th 
of  March,  by  the  Rev.  R.  H.  Harris,  Edmund  J.  A. 
Rogers,  Esq.,  M.D.,  L.R.C.P.,  and  L.R.C.S.,  Ed.,  of 
Denver,  Colorado,  youngest  son  of  the  late  J.  G.  Rogers, 
of  Grafton,  Ont.,  to  Maria  Georgina,  second  daughter 
of  G.  S.  Burrell,  Esq. 

DEATH. 
At  Ancaster,  on  Friday,  the  24th  of  March  Henry 
Orton,  M.D.,  aged  50  years. 

Dr.  Yates,  one  of  Kingston's  most  eminent 
physicians,  a  late  surgeon  of  "  A  "  battery, 
Quebec,  is  dead.  He  came  to  Kingston  fifty 
years  ago. 


THE 


\Hb 


dtanabiati  hmml  of  fflteal  Sriemt 


A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


U.  OGDEN,  M.D., 


R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond., 


y  Consulting  Editors. 


A.  H.  WRIGHT 
L  H.  CAMERON. 


,  B.A.,  M.B.,  M.R.C.S.,  Eng.,  lEditon 
»,  M,B.,  > 


SUB8CRIPTIOIV,  93    PER   AlVNVin. 


^9*  All  literary  oommunicatlons  and  Sxchanges  should  be  addxessed  to  Dr.  CAMBRON,  273  Sherboume  St. : 

or,  Dr.  WRIGHT,  312  Jarvis  St. 
^yAll  businees  communications  and  remittinces  should  be  addressed  to   HART  &  COMPANY,  PubllBbers, 

31  and  33  King  Street,  Toronto. 


TORONTO,  MAY.  1882. 


NOTES   ON  THERAPEUTICS    AND 
PHARMACOLOGY. 

BY  R.  L.  MACDONNELL,    B.A.,  M.  D.,    M.R.C.S.,    ENG. 

(Assistant  Demonstrator  of  Anatomy,  McGill  Univer- 
sity, Montreal,  Physician  to  Montreal  Dispensary.) 

THE     TREATMENT    OF     ACUTE      RHEUMATISM     BY 
SALICIN  AND  SALICYLATE  OF  SODA. 

At  the  discussion  of  this  interesting  subject 
at  the  meeting  of  the  Medical  Society  of  Lon- 
don, held  on  the  16th  January,  1882,  papers 
were  read  by  Dr.  Douglas  Powell,  Dr.  Gilbart 
Smith,  and  Dr.  Broadbent. 

Dr.  Douglas  Powell  had  treated  32  cases 
in  his  ward  at  the  Middlesex  Hospital  since 
January,  1881,  and  of  these  15  had  primary 
rheumatism,  and  in  17  cases  the  patients  had 
suffered  one  or  more  previous  attacks.  Of  the 
15  primary  cases  there  were  previous  heart 
complications  in  7  out  of  the  15  admitted  with 
primary  rheumatism,  and  in  12  out  of  17 
admitted  with  second  or  third  attacks.  Sta- 
tistics of  relapses  depend  upon  what  is  meant 
by  a  true  relapse,  and  figures  brought  forward 
show  that  although  the  salicyl  compounds  are 
more  immediately  efficacous  in  neutralizing  the 
activity  of  the  rheumatic  poison,  yet  they  do  not 
eradicate  it,  or  influence  the  process  of  its 
manufacture  as  do  other  drugs,  and  especially 
perhaps  the  alkalies.  Of  his  32  cases,  in  only 
7  instances  could  he  regard  the  disease  as  having 
subsided  by  the  5th  day,  these  cases  being 
retained  in  hospital  19,  45  (relapse  10th  day) 
21,  14,  16,  17,  and  17  days  (slight  relapse  of 
pain)  respectively,  and  giving  two  cases  of 
relapse.     But  even  in  these  cases  by  "  aubsi- 


dence  "  of  active  symptoms,  he  does  not  infer 
cessation  of  the  disease.     The  mean  period  of 
convalescence  was  the  15th  day  for  the  men* 
and   the    12th  day  for  the  women,  the  tota 
relapses  in  32  cases  being  six. 

Joint  inflammation  and  pyrexia  do  not  in- 
clude the  essential  features  of  acute  rheuma- 
tism, any  more  than  pyrexia  and  diarrhoea  do 
those  of  enteric  fever.  Under  whatever  plan 
adopted  the  disease  still  exists  so  long  as  the 
tongue  remains  coated,  and  the  secretions  dis- 
ordered ;  then  will  relapse  follow  upon  any 
exposure,  exercise,  or  improved  diet.  The 
successful  treatment  of  rheumatism  is  one  of 
many  details,  and  the  danger  of  accepting 
abatement  of  pain  and  fever  as  evidence  of  the 
termination  of  the  disease  lies  in  this,  that 
precautions  are  relaxed  both  on  the  part  of  the 
patient  and  his  attendants. 

As  regards  heart  complications  Dr.  Douglas 
Powell's  impressions  of  the  salicyl  treatment 
are  favourable.  Hyperpyrexia  he  has  met 
with  but  twice,  and  that  in  pi'ivate  practice. 
In  the  first  case,  that  of  a  lady  with  aortic  dis- 
ease of  an  old  date,  it  was  a  second  attack  and 
mild.  The  pains  and  temperature  rapidly 
subsided  under  twenty  grain  doses  of  salicylate 
of  soda,  administered  every  four  hours  ;  but 
whilst  the  patient  was  still  deafened  from  the 
drug  the  temperatui'e  rapidly  rose,  and  she 
died  suddenly  when  it  reached  107",  before  a 
bath  could  be  prepared.  In  the  second  case 
hyperpyrexia  set  in  with  delirium  proceeding 
to  complete  insensibility,  whilst  the  patient  was 
taking  the  salicylate  of  soda  in  twenty  grain 
doses.  He  saw  the  case  when  the  temperature 
was  107°,  and  before  a  bath  could  be  prepared 
it  had  risen  nearly  to  108°.     By  the  addition 


146 


CANADIAN  JOURNAL 


of  large  lumps  of  ice  to  the  bath  the  tempera- 
ture was  in  an  hour  rednced  to  100°,  the 
patient  restored  to  comfort  and  consciousness. 
He  died  three  days  later,  probably  from  some 
lung  complication.  No  post-mortem  was  held 
in  either  case. 

Dr.  T.  Gilbart  Smith,  Assistant  Physician  to 
the  London  Hospital,  spoke  more  of  the  effects 
of  the  salicyl  compounds  on  the  heart  compli- 
cations of  acute  rheumatism.  He  concludes 
bis  address  with  the  following  statement : 
"  That  notwithstanding  our  expectations  based 
on  the  good  effect  of  the  salicyl  compounds  in 
several  of  the  marked  features  of  rheumatic 
fever,  there  is  no  evidence,  so  far  as  hospital 
statistics  are  concerned,  to  show  that  the  in- 
troduction of  the  salicylate  treatment  has'  led 
to  any  diminution  in  the  amount  of  cardiac 
complication  in  acute  rheumatism." 

The  concluding  address  at  the  meeting  was 
that  of  Dr.  Broadbent.  He  has  treated  90 
cases  mainly  with  the  salicylate  of  soda,  and 
thinks  that  after  the  administration  the  pain 
subsides  with  extreme  rapidity,  and  the  fever 
also  ;  and  whatever  the  ultimate  results  may 
be  the  immediate  relief  afforded  is  most  strik- 
ing. As  regards  cardiac  complications  he 
recognized  the  fact  that  salicyl  compounds  had 
no  influence  whatever  upon  the  course,  cer- 
tainly of  pericarditis,  and  a  very  small  influ- 
ence on  the  course  of  endocarditis,  and  that 
not  only  was  the  lesion  itself — the  inflammatory 
cardiac  lesion — unaffected,  but  when  one  had  to 
deal  with  cardiac  inflammations  the  fever 
failed  to  subside  under  the  salicylates.  In 
endocarditis  the  resistance  to  the  effects  on 
temperature  of  the  salicyl  compounds  is  not  so 
marked  as  in  pericarditis.  In  many  of  the 
cases  in  which  the  temperature  persists  after 
the  alleviation  of  pain,  it  is  due  to  the  exist- 
ence of  endocarditis.  Cardiac  weakness,  the 
result  of  the  administration  of  salicylates,  is 
unknown  to  Dr.  Broadbent  as  a  permanent 
affection,  but  he  has  seen  a  high  temperature 
rapidly  go  down  leaving  a  very  weak  and  in- 
frequent pulse.  This  happens  also  after  the 
defervescence  of  relapsing  fever  as  well  as  in 
pneumonia.  "  If  facts  can  settle  a  question, 
then  I  consider  that  the  value  of  the  salicylic 
treatment  of  rheumatic  fever  mav   be   consi- 


dered  as   settled I  think    we 

may  say  definitely,  that  by  means  of  salicylic 
compounds  the  duration  of  the  pain  and  fever 
in  iheumatisni  is  unmistakably  lessened ;  and 
even  if  the  stay  in  hospital  is  not  materially 
shortened,  certainly  the  suffering  is  very  greatly 
diminished.  With  regard  to  relapses,  perhaps 
we  may  say  that  they  seem  to  be  more  com- 
mon under  the  new  than  under  the  old 
methods  of  treatment.  Still,  I  am  quite  sure 
that. the  explanation  of  this  is  to  be  found  in 
the  rapidity  with  which  all  the  acute  symptoms 
subside  under  the  administration  of  salicylates. 
You  cannot  in  these  circumstances  get  the 
patients  to  be  so  careful  of  themselves  as  when 
they  have  gone  through  the  terrible  sufferings 
of  an  unalleviated  attack  of  acute  rheumatism." 
Dr.  Broadbent  does  not  believe  that  the- 
salicylates  increase  the  frequency  of  heart  dis- 
ease ;  on  the  contrary  he  coincides  with  the 
hope  and  anticipation  expressed  by  Dr.  F^gge, 
jn  the  early  part  of  the  discussion,  that  when 
salicylates  are  brought  to  bear  upon  the  fever 
in  the  first  days  of  its  existence  we  shall  see  a 
notable  diminution  in  the  heart  disease.  In 
his  experience  it  was  rare  to  see  cardiac  com- 
plications springing  up. 

MEDICATED    INHALATIONS    IN    LUNG    DISEASE. 

The  treatment  of  lung  diseases  is  one  of  the 
opprobria  of  the  medical  art.  Expectorants 
notoriously  are  unreliable  and  uncertain  iu  their 
effects,  hence  we  look  with  interest  on  the 
growing  practice  of  treating  these  diseases  by 
inhalations  of  volatile  substances  since  we  have 
seen  this  line  of  practice  yield  such  good  results 
in  laryngeal  diseases.  M.  Guillemin,  *(Arch. 
Med.  Belgiques  linllet  81),  gives  the  r»'sult  of 
his  experience  in  the  use  of  medicated  vapours  ; 
warm  aromatic  vapours  relieve  pain  and  cough 
in  the  early  period  of  acute  inflammatory  dis- 
orders. The  addition  of  one  of  the  volatile 
sedatives  (ether,  cherry  laurel  water,  or  hem- 
lock), increases  this  effect.  The  terebinthinates 
arrest  the  progress  of  such  disease.  Vapour 
of  iodine  increases  secretion  and  tendency  to 
cough,  hence  is  useful  in  diminishing  the 
tenacity  of  the  morbid  products  of  secretion,  and 

•Quoted  in  the  April  number  of  the  American  Journal 
of  the  Medical  Sciences. 


OF  MEDICAL  SCIENCE. 


147 


provoking  a  cough  to  expel  them.  Iodine 
arrests  decomposition  in  the  tubes.  The  inhal- 
ation of  turpentines  diminishes  the  quantity  of 
secretion  and  aigments  its  consistence.  It  can 
arrest  the  formation  of  pus,  and  is  indicated  in 
all  affections  of  the  respiratory  mucous  mem- 
brane accompanied  with  a  profuse  formation  ot 
muco-purulent  secretion.  It  should  be  avoided 
■when  there  is  difficulty  of  expectoration  from  a 
too  great  tenacity  of  the  secretion.  Inhalations 
of  turpentine  are  indicated  in  haemopty.^'is 
especially  when  of  moderate  intensity. 

The  giving  of  inhalations  is,  after  all,  not 
such  a  troublesome  affair  as  many  suppose.  The 
vapour  terebinthinal  of  the  Brompton  Con- 
sumption Hospital,  answers  the  purpose  admir- 
ably. It  is  composed  of  one  drachm  of  spirits 
of  turpentine,  with  three  drachms  of  tincture 
of  larch,  is  put  into  a  suitable  vessel  and  over 
the  turpentine  is  poured  half  a  pint  of  hot 
water.  I  have  used  creasote  with  good  effect 
in  this  way,  following  Ringer's  advice  in  dispen- 
sing with  a  special  inhaler  and  using  a  common 
jug.  In  a  case  of  plastic  bronchitis,  I  believe 
it  gave  great  relief  by  checking  the  formation 
of  tough  secretion. 

USES    AND    DANGERS    OF    IODOFORM. 

This  powder  which  has  been  found  so  useful  in 
the  past  few  years  is  now  attracting  attention, 
and  many  new  virtues  are  being  fo-md  in  it.  It 
has  been  described  in  modern  therapeutical  works 
as  a  local  anaesthetic  and  alterative,  and  has 
been  use.  internally  in  the  cases  in  which  iodine 
is  indicated.  It  is  now  coming  to  the  front  as 
an  antiseptic.  Mickulicz  (Wiener Med.  Wochen- 
scU-ift  1881,  No.  23),*  claims  that  in  this  role 
it  is  supej  ior  to  carbolic  acid,  is  more  easily  used 
and  less  apt  to  cause  constitutional  disturbance 
by  absorption.  Poisoning  by  iodoform,  how- 
ever, does  occur,  and  is  usually  of  the  narcotico- 
irritant  type.  In  open  wounds  iodoform  is 
sprinkled  over  the  surface,  covered  with  lint 
and  gutta  percha  tissue,  and  the  whole  diessin^ 
is  kept  in  place  by  a  bandage.  Discharge  is 
slight,  decomposition  never  occurs,  and  there  is 
a  rapid  formation  of  healthy  granulations. 
Iodoform  is  specially  useful  in  those  wounds 
whic  ',  as  in  operations  about  the  rectum  and 

*  American  JouttuiI  of  Medical  Sciences,  April,  1882. 


mouth  are  difficult  to  trea'  antiseptically.  Gauze 
compresses,  saturated,  with  iodoform,  prevent 
offensive  smell,  and  cause  no  discomfort  to  the 
patient.  Its  effect  in  lupus  is  said  by  Riehl* 
to  be  gratifying.  The  epidermis  when  neces- 
sary, having  been  removed  by  the  application 
of  5  to  10  p.  c.  solution  of  caustic  potash,  the 
iodoform  is  laid  on  in  a  layer  several  millimetres 
thick,  and  fi^ed  as  above  described.  This 
treatment  was  carried  out  in  twenty  cases  in 
K  posi's  clinique.  On  removal  of  the  dressing 
in  three  to  eight  days  the  disease  was  found 
comj)letely  removed,  red'iess  an.'  swelling  gone, 
and  the  sore  skinned  over. 

In  deep  wounds  Mikulicz  recommends  pencils 
composed  of  one  part  of  iodoform  to  two  of 
cacao  butter,  and  for  injection  a  20  p.  c.  ethereal 
solution.  The  smell  of  the  drug  can  be  over- 
come by  adding  one  minim  of  bergamot  to  ten 
grains  of  iodoform,  or  moistening  the  powder 
with  an  ethereal  or  alcoholic  extract  of  tor.quin 
bean.  Mr.  Walter  Whitehead,  (British  Medical 
Journal,  March  11th,  1882),  proposes  to  con- 
ceal its  odour  when  used  on  venereal  sores  in 
in  the  following  way  :  Paint  the  sores  with  an 
ethereal  solution  of  iodoform.  In  a  few  momenta 
put  on  a  coating  of  collodion,  and  on  top  of  this 
a  little  absorbent  cotton  wool.  A  similar  plan 
is  practised  by  Dr.  G.  H.  Fox,  (New  York 
Medical  Record),  to  prevent  discolouration  from 
chrysophanic  acid  in  psoriasis.  He  rubs  up  the 
acid  into  a  paste  with  water,  and  then  paints 
collodion  over  the  patch. 

Iodoform  as  a  application  to  cancers,  ulcers, 
and  burns  is  universally  in  use.  In  diseases  of 
the  nose,  too,  ozoena,  ulcers  of  the  septum,  <fec. 
it  may  be  blown  up  the  nostril  alone,  or  in  com- 
bina*  ion  with  any  other  powder,  i  he  employ- 
ment of  which  the  particular  casv>  may  render 
advisable,  bis  nuth,  tannic  acid,  oxide  of  zinc, 
(Medical  Times  and  Gazette,  Jan.  14th,  1882). 
Dr.  Sands,  of  the  Roosevelt  Hospital,  pub- 
lishes a  lecture  upon  this  subject  in  the  New 
York  Medical  Record,  and  confirms  all  that  has 
alieady  been  stated.  He  has  met  with  several 
cases  of  the  milder  form  of  iodoform  |X)isoning 
where  there  were  headache,  anorexia,  insomnia 
and  other  exaggerations  of  nervous  sensibility. 
Of  the  two  cases  one  i-ecovered,  the  other  died 
with  acute  mania. 


148 


CANADIAN  JOURNAL 


Iodoform  iDternally  in  goitre,  is  spoken 
favourably  of  by  Boechat  in  the  Corres  fiir 
Schweizer  Aerztze,  No.  1, 1882,  (quoted  by  the 
London  Medical  Record).  In  soft  goitres  of 
recent  date  it  is  said  to  be  especially  serviceable. 

In  my  father's  practice  iodoform  internally 
had  a  remarkably  good  efitct  in  a  case  of  goitre 
occuring  in  a  young  lady  about  17  years  of  age. 
The  tumor  gradually  disappeared,  and  I  have 
seen  no  return  of  it  in  the  last  seven  or  eight 
years. 

THE   TREATMENT   OP   EPILEPSY. 

Although  there  is  much  satisfaction  in  using 
a  remedy  alone,  yet  we  find  in  many  instances 
an  advantage  to  be  derived  by  the  mixture  of 
several   different  agents   capable  of  producing 
the  same  effect  in  different  ways.    For  example, 
iron    and    quinine,    are,    when    combined,    a 
more  excellent  tonic  than  either  one  alone.     It 
has  long  been  claimed  that  a  combination  of 
bromides  makes  more  headway  against  epilepsy 
than  bromide  of  potassium  alone.     The  experi- 
ence of  Brown  Sequard  was  to  this  effect,  and 
his  formula*  is  in  constant  use  in  the  present 
day.     In  the  Journal  de  Med.  de  Paris,  Jan- 
uary 21st,  1882,  Prof.  Ball  recommends  the  use 
of  the  alkaline  bromides,  particularly  those  of 
ammonium   and  sodium,  with  belladonna  and 
oxide  of  zinc.     He  administers  these  bromides 
of  each  10  parts  in  300  of  water,  commencing 
with  teaspoonful-doses  four  times  a  day,  and  in- 
creasing up  to  eight  or  ten  doses  daily,  if  the 
treatment   is   not    followed    by    improvement 
within  a  few  days.     The  belladonna  and  the 
oxide  of  zinc  are  given  in  pill  form,  15  grains 
of  each  being  made  up  into  forty  pills,  and  of 
these,  two  are  taken  daily,  one  in  the  morning 
and  one  in  the  evening  ;  four  pills  can  be  given 
daily  in  rebellious  cases  without  causiiig  any 
inconvenience.      For  many  reasons  he  prefers 
this  double  salt  to  the  other  bromides  ;  it  does 
not  produce  the  headache  or  torpor  generally 
following  the  prolonged  use  of  the  bromide  of 
potassium,  and  even   when  a  cure  is  not  pro- 
duced the  double  bromide  diminishes  the  fre- 

*Take  Potass.  lodid.,  one  drachm  ;  Potass.  Bromid, 
one  ounce  ;  Ammon.  Bromid.,  two-and-a-half  drachms ; 
Pot.  Bicarb.,  two  scruples ;  Infus.  Calumbse,  six  ounces  ; 
Mix.  —  One  drachm  before  each  meal,  and  three 
drachms  at  bed-time. 


quoncy  and  intensity  of  the  attacks,  even  in 
cases  where  the  bromide  of  potassium  has  failed. 
The  eruption  following  the  use  of  the  potassium 
salt  is  rarely  seen  when  the  double  bromides  are 

used. 

■  ■»■ » 

CASES  IN  PRACTICE. 

BY    J.    FERGUSON,    B.A.,    M.B.,    L.R.C.P.E.,    L.F.P.S., 

GLASGOW, 

(Assistant  Demonstrator  of  Anatomy,  Toronto  School 

of  Medicine.) 

CHRONIC  GONORRHCEA. 

Mr.  A.  J.  took  very  sick  one  morning  and 
sent  for  me.     He  gave  me  his  age  as  19  years, 
which  I   think   was   about   correct.     His  tem- 
perature was   103°  F.  ;  pulse  101  per  minute. 
There  was  a  good  deal  of  tenderness  in  the  left 
iliac  region.     I  found,  on  enquiry,  that  he  had 
been  afflicted  with  gonorrhoea  for  nearly  two 
years.     During  this  time  he  had  received  his 
share  ot  treatment.     A  few  days  previous  to 
the  date  of  my   visit,   he  had   been  drinking 
some,  though  his  habits  are  steady.     This  had 
set  up  an  acute  attack  out  of  the  chronic  one 
already  existing.     I  gave  him  a  saline  laxative 
and  the  following  mixture  : — Pot  bromidi  5iv.^ 
Tr.  gelsemii  5ii.,  liq.  ammon.   acetat  ^ii.,  aquae 
a4    5viii.,    Jss.    three    times    a    day.     In   a 
few  days  he   was  out  of  bed  and  came  to  my 
office.     He  told  me  that  the  stream  of  water 
had  been  gradually  getting  smaller  for  a  con- 
siderable time.     I  found  there  was  commencing 
stricture,  and  that   there   had  always  been  a 
thick  mucous,  and  often  a  purulent  discharge 
from  the  urethra,  in  spite  of  medication.     I  at 
once  adopted  the  syphon  treatment,   whicl\  I 
described  in  the  Canadian  Journal  of  Medi- 
cal Science,  for  July,  1881.    After  the  fourth 
day  all  discharge  ceased  ;  but  washing  of  the 
urethra  was  continued  for  ten   days,  morning 
and  evening.     Catheters  were   then  passed  at 
each  sitting  daily  for  one  week,   ranging  from 
No.  6  to  No.  10.     He  has  now  been  free  from 
all  trouble,  both  with  regard  to  the  discharge 
and  threatened  stricture,  for  a  period  of  rather 
more  than  two  months. 

SICK  headache. 
Mrs.  B.  has  been  a  victim  to  this  trying  in- 
firmity for  about  eight  years  ;  but  for  the  laat 


OF  MEDICAL  SCIENCE. 


149 


two  years  her  coudition  has  been  very  wretched, 
rarely  escaping  for  a  longer  period  than  three 
weeks,  often,  however,  having  an  attack  at 
intervals  of  ten  da>  s.  The  suflering  in  this 
case  was  intense,  and  the  vomiting  excessively 
severe.  This  condition  had  induced  a  good 
deal  of  debility,  and,  what  is  worse,  despond- 
ency. I  suggested  various  remedies,  but  was 
not  very  well  satisfied  with  my  results. 
Shortly  after  one  of  her  attacks,  which  was  of 
more  than  usual  severity,  1  began  giving  her 
nitro-glycerine.  One  minim,  of  the  one  per 
cent,  solution  was  used  for  a  time,  thrice  daily, 
and  then  gradually  increased  till  she  was 
taking  two  minims  at  each  dose.  At  first 
there  was  considerable  discomfort  caused  by 
the  remedy  in  the  form  of  giddinness  and 
nausea.  There  was  no  vomiting  however,  and 
the  patient  continued  faithfully  taking  her  new 
agent.  Since  this  treatment  was  commenced 
she  has  not  had  a  single  attack  in  a  period  of 
fourteen  weeks,  a  state  of  things  unknown  to 
her  for  many  years.  This  immunity  from  the 
attacks  has  greatly  improved  her  general 
health,  and  this  will  be,  no  doubt,  an  im- 
portant factor  in  finally  securing  a  good  result, 

A    STRANGE    CASE. 

Mr.  H.  W.,  one  evening  at  tea  accidentally 
bit  the  side  of  his  tongue ;  but  as  there  was  no 
great  amount  of  pain,  paid  very  little  more 
than  a  passing  notice  to  the  afiair,  Next  day 
the  tongue  began  to  swell  and  became  pretty 
painful,  interfering  a  good  deal  with  masti- 
cation. Still  but  little  attention  was  given  the 
matter  until  the  second  day  after  the  biting 
took  place.  T  saw  the  patient  about  two  p.m., 
and  found  pretty  severe  glossitis  with  the 
organ  very  much  swollen.  The  pulse  was  99, 
the  temperature  100°F.,  and  the  bowels  con- 
stipated. I  ordered  pulv.  jalapae  co.  gr.  xx., 
hydrarg.  subchl.  gr.  v.  for  one  dose,  and  tr. 
opii  m.  X.  vini  antimonialis  m.  x.  Liq.  am- 
mon.  acetat  5ii.,  aquae  ad.  ji.  every  four  hours. 
Next  day  I  found  the  pulse  90,  temperature 
99,  and  that  the  bowels  had  been  freely  moved. 
The  tongue,  however,  was  still  greatly  swollen, 
and  the  gums  were  soft  and  tender.  I  scarified 
the  tongue  and  encouraged  bleeding  by  wash- 
ing out  the  mouth  with  tepid  water,  and  making 


the  patient  sack  his  own  tongue.    Pot  chloratis 
51.,  aquse  Jiv.  was  ordered  as  a  wash  for  the 
mouth,  and  the  mixture  changed  to  tr.  ferri. 
perchl.   m.  xv.,   acid,    phosphor,    dil.    m,    xv,, 
quiniae.  sulph.  gr.   ii.,  aquse  Jiss.    every  four 
hours,  to  be  swallowed  through  a  glass  tube. 
Next  morning  the  condition  ot  the  tongue  was 
greatly  improved,  and  the  general  appearance 
of  the  patient  good.     Pulse  88,   temperature 
98  8.     The  same  medicine  continued.     About 
1  a.m.  of  the  following  day  I  was  sent  for.    On 
arriving  I  found  the  patient  lying  on  his  back, 
tossing  his  arms  about,  and  complaining  of  a 
severe    sufibcating    feeling,     with    occasional 
coughing.    Careful  examination  revealed  noth- 
ing the  matter  with  the  lungs.    There  had  been 
some  vomiting.     The  heart  was  beating  about 
150  per  minute,  the  pulse  could  not  be  felt  in 
left  wrist,  while  in  the  right  it  was  too  feeble 
to  be  counted,  and  the  rate  of  circulation  had 
to  be  taken  over  the  heart  with  a  stethoscope. 
The  strange  feature  was  that  the  two  sides  of 
the  heart  were  not  keeping  time,  but  completely 
out  of  rhythm,  and  trotting  along  like  a  span 
of  horses.     There  was  also  great  pain  over  the 
aodomen  genei'ally,  but  especially  between  the 
ensiform   cartilage   and    the   umbilicus.     The 
temperature  was  1001  F.     Tr.  opii.  m.  xv.,  tr. 
digitalis  m.  xv.,  vini  ipecacuanha  m.  x.,  acid  hy- 
drocyan.  dil.  m.  v., aquse  Ji.  every  four  hours  was 
ordered,  and  a  turpentine  fomentation  placed 
on  the  abdomen.     I  saw  him  about  eleven  a.m. 
of  the  same  day,  and  found  the  pain  very  much 
abated;  the  heart  beating  130  per  minute,  tem- 
perature 99,  and  the  radial  pulses  returning ; 
rhythm  still  irregular.     The  same  mixture  con- 
tinued.    I  saw  him  again  at  six  p.m.  ;  pain  and 
tenderness  almost  gone,  pulse   89,  temperature 
98  5,  respirations  20  per  minute,  often  sighing, 
complained  of  being  sleepless.    He  was  ordered : 
Pot.    bromid.     gr.    xv.,    pot   iodidi  gr.  v.,  tr. 
aconiti.  m.  iss.,  aquse  5i.  every  four  hours.    He 
was  seen  the  next  day  at  noon  ;  had  a  good 
sleep  during  the  latter  part  of  the  night ;  pulse 
80,  temperature    99  1,    and    coughing  a    good 
deal.     He   had  expectorated  during  forenoon 
some  prune-juice-like  fluid,  but  no  symptoms 
of   pneumonia   could    be   found;    bowels   con- 
I  stipated.     I  gave  him  ammon.  chlorid  gr.  x., 
spts.  chloroform,  m.  x.,  syr.   5ss.,  aquse,  3ji. 


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every  two  or  three  hours,  and  a  pill  of  pulv., 
ipecac,  gr.  i.,  pil  al.  et  myrrh,  gr.  iii.,  ext. 
nucis.  vom.  gr.  \,  to  be  repeated  each  day  if 
needed.  On  my  visit  the  next  day  I  found  the 
state  of  things  very  favourable.  There  were 
some  moist  lales  in  right  lung,  which  could 
only  be  heard  from  the  axilla.  Same  treat, 
ment  continued.  On  my  next  visit :  Acid, 
hydrocyan  dil.  5i.,  acid,  nitric,  dil.  5ii.,  gly- 
cerine 5vj.,  infusi  quassise  ad  ^^j.,  S^s-  thrice 
daily  was  ordered. 

The  peculiar  points  are  the  simple  cause  of 
so  much  constitutional  disturbance ;  the  good 
health  previous  to  biting  of  tongue ;  the  ab- 
dominal pains  ;  the  strange  action  of  heart, 
which  is  quite  normal  now,  the  pulmonary 
complications,  and  the  tendency  to  constipa- 
tion. 


PROCIDENTIA  OF  THE  GRAVID 
UTERUS. 

BY  JAMES  ROSS,  M.D.,  TORONTO. 

On  account  of  the  rarity  of  procidentia  of  the 
gravid  uterus,  and  of  the  connection  between 
this  case  and  one  recently  reported  in  the 
British  Medical  Journal,  I  send  you  the  notes 
of  it  from  my  case  book. 

Mrs.  J.  O.  sent  for  me  May  23rd,  1870,  in 
great  haste.  Arriving  at  the  house  within  half 
an  hour  I  was  told  that  she  had  been  to  the 
market  and  had  started  for  home  carrying  a 
large  basket  of  provisions.  When  she  felt  some- 
thing suddenly  give  way  and  sank  immediately 
to  the  sidewalk.  "  I  felt,"  she  said,  as  if  my 
inside  were  coming  out."  She  was  assisted 
home  and  I  found  hfr  in  bed.  She  was  seven 
months  pregnant  with  her  second  child.  There 
had  been  nothing  unusual  about  the  first 
labour. 

Upon  examination  I  discovered  a  complete 
luxation  of  the  uterus ;  it  lay  as  a  large 
tumour  between  the  thighs,  partially  exter- 
nal to  the  labia  which  were  stretched  over 
it.  The  outlines,  position,  and  movements  of 
the  foetus  could  be  easily  felt  and  seen. 

I  placed  pillows  under  the  hips  to  raise  them 
well  and  reduced  the  luxation  without  much 
trouble.  She  was  given  an  opiate  ;  a  perineal 
band  was  adjusted  over  a  large  pad  made  from 


napkins,  and  the  recumbent  position  main- 
tained and  insisted  upon.  In  three  weeks  she 
was  allowed  to  be  up  and  went  about  as  usual. 
Gestation  continiied  to  term.  I  delivered  her 
of  a  fine  female  child  on  the  ninth  of  July. 
The  labour  was  quite  natural.  The  date  of  the 
occurrence  of  the  procidentia  was  May  23rd 
and  of  delivery,  July  9th,  a  period  of  forty- 
seven  days  intervening. 

Both  mother  and  child  are  still  living.  The 
mother  has  been  troubled  with  slight  prolapsus 
since,  but  is  otherwise  in  excellent  health.  Her 
menses  have  been  regular  and  her  second  is  as 
yet  her  last  child.  I  hardly  think  it  likely 
that  she  will  ever  become  pregnant  again.  In 
5,686  cases  of  labour,  this  is  the  only  one  of  the 
kind  with  which  I  have  met. 


THE  PROPER  MODE  OF  PRESERVING 
VACCINE. 

BY    J.    FERGUSON,    M.D. 

I  think  all  who  have  tried  "  ivory  points' 
and  "  quills  "  are  thoroughly  satisfied  that  they 
are  not,  reliable  by  any  means.  If  the  vendors 
would  only  put  up  the  vaccine  in  capillary  glass 
tubes,  sealing  their  ends  by  means  of  a  spirit 
lamp,  trouble  would  be  at  an  end.  The  mode 
of  filling  is  extremely  easy.  The  end  of  the 
tube  is  touched  against  the  lymph,  escaping 
from  the  vesicle,  and  is  at  once  charged  by  the 
fluid  flowing  along  its  lumen.  Each  end  is 
then  quickly  plunged  into  a  spirit-lamp,  or  gas 
flame,  this  melts  the  glass,  and  completely  pro- 
tects the  lymph  fi-om  the  air.  In  this  way  it 
can  be  kept  good  for  an  indefinitely  long  time. 
The  sealed  ends  are  snipped  off  when  used. 
I  used  hundreds  of  these  tubes  in  Britain  and 
never  knew  a  failure.  I  prepared  a  considera- 
ble number  for  my  own  use,  which  were 
as  sure  as  those  provided  by  the  regular  vaccine 
houses.  This  mode  of  keeping  the  lymph  was 
first  brought  before  the  profession  by  Dr. 
Husband,  of  Edinburgh,  and  is  undoubtedly  the 
best.  It  is  almost  universally  adopted  in  Britain, 
where  failures  in  vaccination  are  almost  unheard 
of.  It  would  be  quite  a  boon  if  our  American 
and  Canadian  producers  could  be  induced  to 
try  this  method  ;  for  this  is  all  that  would  be 
required  to  ensure  its  continuance. 


OF  MEDICAL  SCIENCE. 


151 


Mutiou :  lH^didue. 


APHASIA. 

BY  HUGO   ENGEL,  M.D,,  PHILADELPHIA, 

As  early  as  the  beginning  of  the  present 
centurj  attempts  wei-e     made    to    locate    the 
speech-centre  in    some  particular    part  of  the 
bi-din,  and    while  Gall  thought,  from    several 
cases   in  which   he  had  made  a  post-mortem, 
that  its  seat  was  in  the  hemispheres  of  the  cere- 
brum,   Bouillaud,    and,   later,    Marc  Dax,  de- 
clared that  disturbances  of  speech  were  remark- 
ably often    connected  with  lesions  of  the  le/t 
hemisphere,  and  that  it  was  there  that  "  the 
memory  of  words"  seemed  to  reside.    But  Broca 
was  the  first  to  locate  its  seat  more  precisely, 
and  he  not  only  demonstrated  that  the  speech- 
centre  was  situated  in  the  left    third  frontal 
convolution,  but  he    contended    also  that  the 
faculty  of  speech  was  one  gradually  acquired, 
and  that  the  gray  matter  presiding  over  it  was 
brought  step  by  step  to  a  full  development  on 
the  left  side  in  right-handed  persons.     Of  the 
latter  fact  one  case  especially  convinced  him, 
which  he  has  published  in  the  work  quoted, — 
that  of  a  left-handed  epileptic  female,  in  whom 
after  death  it  was  discovered  that  the  left  front- 
al and  median  lobes  were  totally  absent,  but  the 
right  hemisphere    normally  developed.     Since 
then  many  careful  investigators  have  made  fur- 
ther researches,  and  while  Ferrier,  Hitzig,  and 
others  endeavored  to  localize  anatomically  moi'e 
and  more  precisely  this  function  of  the  brain, 
Kussmaul    locked  at  it  rather    from  a  philo- 
sophical  stand-point,    and  tried   to  establish  a 
minute  subdivison  and  classificatien  of  all  pos- 
sible kinds  qf  disturbance  of  speech,  without, 
always,   however,    the   desirable     pathological 
proof.     When   studying  this  subject,    we  must 
not  forget  the  difficulties  which  the  investiga- 
tor has  to  encounter.     Experiments  on  animals 
are  here  necessarily  out  of  the  question;  only 
by  quasi-exclusion  could  they  be  of  any  assist- 
ance ;  and  such  morbid  lesions  in  man  are  so 
rarely  suflSciently  circumscribed  that  but  a  very 
gradual  advance  can  be   possible  in  our  know- 
ledge of  the  precise  seat  of  the  memory  of  words. 
It  is  only  by  a  skilful  analysis  of  cases  of  which 
an  exact  history  of  the  symptoms  has  been  re- 


corded, and  of  the  very  localized  lesions  of 
which  a  minute  examination  has  been  made, 
that  we  can  slowly  progress  in  this  direction  ; 
and  such  cases  are  rare.  These  difficulties  form 
one  of  the  causes  why  aphasia  i'as  been  so  much 
the  subject  of  philosophical  theories.  But,  after 
long  and  patient  labor,  "Wernicke  has  brought 
some  order  again  into  the  chaos ;  and,  while 
giving,  in  the  following,  mainly  the  result  of 
his  researches,  we  may  say  that  we  describe 
about  all  that  at  present  is  actually  known  of 
the  seat  of  the  speech-centre,  or,  in  one  word, 
of  aphasia,  ^nd  the  truth  of  which  has  been 
sufficiently  proven  by  pathological  cases. 

There  are  two  centres  in  the  brain  for  the 
function   of   speech,   situated    both,    in  right- 
handed  persons,  in  the  left  hemisphere  of  the 
cerebrum.     Of   course  we  do    not  understand 
here  by  "  speech  "  the   articulation,  the  mere 
sound  of  the  voice  as  produced  by  the  different 
muscles  of  the  larynx  and  buccal  cavity,  etc., 
the    nervous  centre   for  which  resides  in  the 
olivary  bodies   of  the  medulla  oblongata,  and 
which,   by   training,   may   to  a  certain  extent 
even  be  developed  in  animals  (parrots,  etc.);  we 
mean  the  centre  of  language,  the   memory   of 
words,  that  centre  which  employs  the  one  for 
articulation  simply  as  a  means  for  executing  its 
orders.     For  this  speech-centre  there  exist,  as 
mentioned,   two  centres   iu  the  brain.     First, 
the  sensory,  situated   in  the  first  temporal  con. 
volution,  the  cortical  end  of  the  acoustic  paths, 
— the    depository  of  words,   as  they    are  com- 
municated to  us  by  the  spoken  language,  by 
talking.     Deep  into  the  white  mass  connected 
with  this  gyrus  the  origin  of  fibres  of  the  audi- 
tory nerve  has  been  traced.     From  this  centre 
an  associating  path,  the  island  of  Reil,  leads  to 
Broca's  centre,  formerly  alone  taken  into  con- 
sideration, the  lower  third  frontal  convolution, 
which  governs  in  the  widest  sense  of    the  word 
the  whole  motor  part  of  expression  by  words  of 
speech. 

Based  upon  the  foregoing,  Wernicke  assumes 
four  different  forms  of  aphasia,  in  one  of  which 
every  possible  kind  of  morbid  disturbance  of 
speech  must  find  its  place 

a.  Motor  aphasia,  or  Aphemia. — Here  the 
motor  centre  is  diseased.  While  the  mobiliiy 
of  the  musclps  of  speech   is  perfectly  intact, 


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patients  are  either  not  at  all  able  to  talk,  or 
can  only  say  a  few  syllables  or  words,  but  they 
understand  everything  spoken  to  them. 

b.  Conduction  Aphasia. — Here  the  associat- 
ing path  is  interrupted,  the  island  of  Reil 
diseased.  The  memory  of  words  is  preserved, 
understanding  is  perfect,  but,  while  talking, 
wrong  words  are  often  used  ;  certain  words  are 
mistaken  for  others. 

c.  Sensory  Aphasia — KussmauVs  Word-DeaJ- 
ness. — The  seat  of  the  lesion  here  is  the  left 
first  temporal  convolution.  The  memory  of 
words  is  intact,  but  words  are  frequently  mis- 
taken for  others,  and,  while  the  facutly  of  hear- 
ing is  perfectly  preserved,  the  speech  is  not 
understood  :  i.e.,  while  the  patient  is  fully  able 
to  hear  the  slightest  noise,  tlie  sound  of  the 
voice,  the  words  spoken  to  him  have  lost  their 
significance,  for  his  brain  cannot  perceive  their 
meaning. 

d.  Total  Aphasia. — Loss  of  all  functions,  with 
destruction  of  both  centres. 

To  one  of  these  forms  every  case  of  aphasia 
will  necessarily  hav^e  to  belong.  Concerning 
agraphia  and  alexia  we  are  forced  to  assume 
other  centres  in  intimate  connection  with  the 
two  main  centres  named  above,  each  perhaps 
forming  a  special  part  of  one  of  the  latter.  In 
the  first  case  (agraphia)  there  must  exist,  with 
full  preservation  of  the  common  mobility  of  the 
right  arm  and  hand,  an  affection  of  the  motor 
centre  for  the  combination  of  the  special  move- 
ments of  writing,  while  the  latter  (alexia)  we  will 
have,  without  disturbance  of  common  vision  in 
disease  of  the  sensory  centre  which  acta  as  the 
receptacle  for  the  image  of  the  figures  of  the 
alphabet,  etc.  The  latter  centre  will  undoubt- 
edly be  found  in  connection  with  the  cortical 
end  of  the  optic  nerve.  That  the  main  centres 
must  also  be  closely  connected  with  the  centre 
of  the  tactile  sense  and  the  cortical  motor 
centre  is  proved  by  the  fact  that  blind  persons 
are  able  to  write  and  read,  and  that  born  deaf- 
mutes  not  only  learn  to  read  and  write  but 
even  to  talk  without  being  able  to  hear.  There 
are  deaf-mutes  who  themselves  prove  the  con- 
nection of  the  optical  'and  tactile  paths  with 
the  speech-centre,  because  there  are  some  deaf- 
mutes,  as  in  the  institution  in  Berlin,  for  in- 
stance, who   understand  the  wof  ds  spoken  by 


8imi)ly  looking  at  the  lips  of  the  speaker,  and 
others  who  are  able  to  do  so  by  applying  their 
hand  either  to  th  >  cheek  or  back  of  the  chest  of 
the  persons  talking.  But  as  it  is  necessary  to 
keep  a  very  careful  record  of  every  symptom  of 
such  cases,  and  as  the  most  minute  dissections 
of  them  have  to  be  made  after  death, — and  how 
rare  is  it  for  such  cases  to  fall  into  the  hands  of 
physicians  who  are  able  and  have  the  time  at 
their  command  to  fulfil  both  conditions! — many 
years  must  elapse  ere  we  may  progress  further 
in  this  direction  and  answer  all  the  questions 
referred  to. 

The  different  forms  of  aphasia — the  inability 
of  the  centres  to  perform  their  functions — can 
be  brought  about  by  all  kinds  of  morbid  pro- 
cesses.   These  affections  may  be  only  temporary 
in  their  character  :   in  such   case   we  will  find 
their  cause   mostly  in  congestion;  or  in  insuffi- 
cient nutrition;  or  in  an  insufficient  quantity  of 
blood;  as,  for  instance,  iu  that  form  of  aphasia 
which   we  observe  in  convalescents  from  grave 
diseases:  here  the  prognosis  is  generally  a  favor- 
able one.     The  same  may  be  said  of  hysteria, 
epilepsy,  and    syphilis  (here,  however,  only    if 
the  degeneration  of  the  arteries  is  recognized 
and   treated    early  enough)    when    acting    as 
causes  of  aphasia.     Cases   due  to  softening  of 
the  brain  or  to  abscess  are,  if  not  rapidly  fatal, 
always  of  long  duration,   chronic,   very  little 
amenable   to   improvement,    and  usually  con- 
nected with  other  symptoms  on  account  of  the 
further  extension  of  the  morbid  process.     Em- 
bolism in  the  branches  of  the  left  arteria  fosase 
Sylvise  is  a  frequent  cause,  and  in  such  cases 
aphasia    and    coma,    without    disturbance    of 
motion,  are  the  characteristic  conseqtiences  of 
this  disturbance  of  circulation.     As  an  excel- 
lent illustration  of  temporary  aphasia  induced 
by  passing  disturbance  of  circulation,  we  will 
narrate  the  following  case,   which  some  years 
ago  happened  in  the  family  of  and  was  attended 
by  the  writer.     A   mentally  very   bright  and 
physically  well-developed  girl,  twelve  years  of 
age,  with   no  hereditary  and  no  constitutional 
taint  whatever,  and  whose  nervous  system  also 
seemed  in   eve.y  respect  well-balanced,  went, 
on  a  warm  day  in  June,  to  a  strwberry-festival 
in  Fairmount   Park.     There,  being  left  for  a 
short   time   without   supervision,  she  indulged 


OF  MEDICAL  SCIENCE. 


153 


with  other  young  g'rls  in  the  dangerous  play  of 
rope  jumping.     Not  to  let  her  mother  observe 
her   excitement,  she  dipped  her  handkerchief 
into    the   cold  water   of  a    spring,    and  while 
heated  applied  it  to  her  burning  face.      Shortly 
after    she    was    brought    in    an   unconscious 
state  to  her  mother.     While  unconscious,  the 
muscles  of  the  right  side  of  her  face  and  of  her 
right    arm   were    in    a    continuous    convulsive 
movement.     Unconsciousness  lasted  about  ten 
minutes  ;  but  on  awakening  out  of  the  coma  she 
presented  the  following  remarkable  symptoms. 
Temperature  increased  one  degree  (surface  tem- 
perature of  the  left  front  part  of  the  head  not 
being  taken) ;  physical  health  seemingly  other- 
wise not  disturbed.   But  her  face  had  the  expres- 
sion of  an  idiot :  she  evidently  did  not  under- 
tand  what  was  said  to  her,  and  could  neither 
speak,   read,  nor   write.     She   put  her  tongue 
out  without  difficulty,  and  there  did  not  seem 
to   be  the  slightest  disturbance  of  motion  or 
sensation.    But  she  showed  a  ravenous  appetite, 
and  would   eat   raw  potatoes  and  almost  any- 
thing she  could  put  her  hands  on,  and  show  as- 
tonishment if  prevented.     Leeches  were  applied 
to  her  left  temple,  followed  by  the   application 
of  a  bladder  containing  ice.     About  four  hours 
after  the  attack — the  face  began  gradually   to 
lose  its  idiotic  expression,  and  the  patient  evi- 
dently  commenced   to   understand    what   was 
said  to  her.     The  following  day  she  had  so  far 
improved    that   she    again    appeai'ed    perfectly 
natural  in  her  actions,  etc.,  but  she  could  not 
talk,  read,  nor  write.     I  then  proposed  to  take 
a  first  reader  and  commence  spelling  over  again. 
It  was  remarkable  to  observe  the  rapid  progress 
she  made.     Suffice  it  to  say  that  within  five  or 
six  days  she  had  almost  perfectly  relearned  the 
the  use  of  words,  and  could  talk,  read,  and  write 
nearly  as  well  as  formerly.     But  it  was  clear 
that  she  had  to  learn  every  word  again  before 
she  was  able  to  make  use  of  it,  and,  though  the 
re-awakening  of  the  faculty  was  a  reraarkably 
quick  one,   the  fact  of  the  memory  of  words 
having   been  temporarily  lost  was  indisputable. 
No  symptom  whatever  since  has  reminded  the 
patient  of  this  attack  of  passing  congestion. 

In  conclusion,  we  may  add  that  from  the 
special  form  of  an  aphasia  other  diagnoses  may 
be   made  also,    as   a  case  of  Senator   proves 


where  he  was  able  to  locate  an  abscess  at  its 
exact  seat  in  the  left  frontal  lobe  from  the 
aphasic  symptoms  alone.  But  sometimes  the 
lesion  is  in  the  white  conducting  and  not  in  the 
cortical  gray  matter.  Such  are  the  cases  of 
which  it  has  been  reported  that,  notwithstand- 
ing aphasic  symptoms  no  lesion  had  been  found, 
because  the  convolutions  alone  had  been  ex- 
amined. Considering  the  great  difficulty  of 
these  examinations,  however,  such  mistakes  are 
excusable  and  cannot  always  be  avoided. — Phil. 
Med.  Times. 


THE  TREATMENT  OF  DIPHTHERIA. 

BY  H.  CRIPPS  LAWRENCE,  L.R.C.P., 
LOND.,  ETC. 

The  following  combination  of  the  glycerols 
of  tannin  and  carbolic  acid  has  proved  itself, 
during  a  considerable  experience  of  diphtheria 
and  scarlet  fever,  a  highly  efficient  application 
in  my  hands,  viz  :  18^  Glycerini  acidi  tannici  5vij; 
Glycerini  acidi  carbol.  5j.  Misce.  In  the  appli- 
cation of  glycerine  as  an  absorbent,  it  is  of 
practical  importance  (as  pointed  out  some  time 
since  in  the  Pharmaceutical  Journal)  that  a 
small  proportion  of  water  should  be  added  to 
it.  In  order  to  secure  this,  a  sufficiency  of  the 
glycerine  should  be  placed  in  a  saucer,  and  a 
throat-brush  dipped  in  water  should  first  be 
stirred  into  the  glycerine  before  applying  it  to 
the  tonsils  and  fauces. 

The  combination  above-mentioned  has  been 
found  practically  the  most  efficient  proportion 
for  securing  the  necessary  astringent  and  anti- 
septic results,  without  irritation.  An  appli- 
cation twice,  or  at  most  thrice,  in  the  twenty- 
four  hours  secures  the  utmost  benefit  the  remedy 
afibi'ds — a  matter  of  importance  both  to  the 
patient  and  practitioner,  as  the  former  is  not 
fatigued  by  frequent  applications,  and  th^i  latter 
can  make  these  personally  at  the  usual  vi.sits. 

It  is  seldom  that  any  additional  local 
remedies  are  required,  but  it  is  wise  to  precede 
the  application  of  the  glycerols  with  gargling 
the  fauces  and  washing  out  the  mouth  with  a 
solution  of  permanganate  of  potass  and  water, 
and  to  use  the  sulphurous  acid  spray;  the  double 
advantage  which  follows  being,  that  the  fauces 
are  the  better  prepared  to  benefit  from  the 
glycerine,  and  thatthesafety  of  the  practitioner 


154 


CANADIAN  JOURNAL 


is  increased  in  the  event  of  the  patient  expec- 
torating any  false  membrane  during  the  act  of 
swabbing.  To  further  increase  the  safety  of 
the  medical  attendant  a  glass  screen,  placed 
between  him  and  the  patient,  will  afford  pro- 
tection without  limiting  the  efficiency  of  the 
procedure. — British  Medicul  Journal. 


Langer  on  the  Chemical  Composition 
OF  Human  Fat  at  Different  Ages. — A 
comparison  of  the  adipose  tissue  in  a  newly- 
born  child  and  in  an  adult  man  discloses 
remarkable  physical  differences.  The  adipose 
tissue  in  the  adult  varies  in  colour  from  clear 
yellow  to  brownish,  and  is  very  soft;  and,  on 
making  a  section  of  the  panniculus  adiposus, 
little  drops  of  oil  exude.  Microscopic  examina- 
tion shows  in  each  fat-cell  one  or  more  clear 
drops  of  oily  matter,  and  it  is  only  in  quite 
exceptional  cases  that  acicular  crystals  of  fat 
are  found,  On  the  other  hand,  the  panniculus 
in  the  body  of  an  infant  is  remarkably  firmer 
and  harder.  It  is  greyish  white  in  color,  and 
readily  crumbles,  like  wax  that  has  been  boiled 
in  water.  On  microscopic  examination,  num- 
erous crystals  are  seen  in  almost  every  cell. 
Dr.  Langer 's  present  researches  show  that  the 
fat  of  the  child  and  of  the  adult  present  essen- 
tial differences  in  regard  to  the  relative  propor" 
tions  of  the  chemical  constituents. 

According  to  Dr.  Langer,  one  form  of 
sclerema  neonatorum  is  connected  with  the 
condition  of  the  fat.  Sclerema  neonatorum  is 
either  a  result  of  serous  infiltration  of  the  skin 
and  subcutaneous  areolar  tissue,  or  of  the 
solidification  of  the  fat  in  the  panniculus  adi- 
posus. The  latter  form  is  to  be  regarded  as  a 
phenomenon  consecutive  on  various  diseases, 
such  as  infiammation  of  the  lungs,  in  the  course 
of  which  collapse  and  lowering  of  the  tempera- 
ture of  the  body  occur.  As  has  been  already 
said,  the  melting  point  of  the  infant's  fat  is  45° 
Cent.  (113°  Fahr.) — that  is,  far  above  the  tem- 
perature of  the  body.  "It  cannot,"  Dr.  Langer 
says,  "be  assumed  that  the  fat  has  a  lower 
melting  point  within  the  body  than  outside  it. 
It  hence  follows  that  even  in  the  living  child 
a  large  portion  of  its  fat  is  not  fluid,  but  only 
ia  a  sufficiently  soft  condition.  If  the  tempera- 
ture  of  the  body  fall,  whether  through  collapse 


or  in  consequence  of  withdrawal  of  heat  from 
without,  it  cm  be  readily  understood  that  the 
fat  in  the  panniculus  adiposus  will  solidify, 
and  a  fatty  sclerema  will  be  produced.  A  fall 
of  the  temperature  to  32°  Cent.  (89.6°  Fahr.), 
sometimes  lasting  for  days  before  death,  is  not 
unfrequently  observed  in  some  illnesses  of 
newly-born  children.  With  such  a  tempera- 
ture, as  I  have  convinced  myself  by  experiment, 
the  fat  in  the  panniculus  adiposus  is  quite 
solidified.  The  occurrence  of  fatty  sclerema 
is  not  possible  in  the  adult,  because  of  the 
different  condition  of  the  fat,  and  because  the 
temperature  of  the  body  can  never  fall  so  low 
during  life  as  to  cause  solidification  of  the  fat 

in  the  adult, 

> «  ♦  >  < 

Nitro-Glycerine  in  Therapeutics  — Prof. 
Kroczynski,  of  Cracow,  in  the  Wien.  Med.  Woch., 
gives  the  following  observations  on  nitro- 
glycerine. 

In  six  persons  afflicted  with  attacks  of 
bronchial  asthma  in  consequence  of  extensive 
emphysema  of  the  lungs  the  nitro-glycerine  con- 
trolled or  lessened  very  materially  the  attacks 
of  difficult  breathing  in  the  course  of  a  few 
minutes,  seldom  later  than  a  quarter  of  an 
hour,  if  taken  at  the  beginning  of  the  attack. 
After  using  the  nitro-glycerine  regularly  for 
some  time  the  attacks  wholly  disappeared  in  four 
out  of  the  six. 

In  thirteen  cases  idiopathic  nervous  asthma 
the  success  was  really  little.  Of  the  thirteen 
cases  there  was  almost  no  improvement  in  seven* 
two  of  which  occurred  in  hysterical  persons, 
in  four  the  benefit  was  doubtful ;  but  in  two, 
accompanied  with  bronchial  catarrh,  it  was 
positive. 

In  two  cases  of  steno-cardia  caused  by  aortic 
aneurism,  the  remedy  acted  very  promptly,  for 
the  attacks  disappeared  each  time  soon  and 
fully.  By  a  lengthy  and  methodical  use  of  the 
drug  the  attacks  ceased  altogether  in  one  of  the 
cases. 

In  three  examples  of  palpitation  of  the  heart 
the  result  was  extremely  satisfactory.  In  two, 
which  were  clearly  of  nervous  origin,  the  pal- 
pitation disappeared  completely  on  the  repeated 
exhibition  of  the  drug ;  in  the  third  case,  where 
an  insufficiency  of  the  semi-lunar  valves  of  the 
aorta  existed,  the  attacks  ceased  for  the  time 


OF  MEDICAL  SCIENCE. 


155 


after  the  occasional  use  of  the  remedy  at  their 
commencement. 

In  six  cases  of  angina  pectoris,  the  results 
were  very  doubtful  in  one,  while  in  the  remain- 
ing five  they  were  excellent.  A  few  minutes 
after  giving  the  nitro-gl)  cerine  the  angina 
fully  ceased  or  became  greatly  modified.  Pro- 
phylactically  the  remedy  was  of  no  use  if  there 
was  any  anatomical  derangement  in  the  heart 
or  vessels  ;  but  if  of  nervous  character  it  was 
of  considerable  value. 

In  a  case  of  chorea  minor,  which  existed  for 
two  years  in  a  congenitally  chlorotic  maiden 
the  treatment  with  bromide  of  zine  and  other 
agents  was  quite  unsuccessful.  On  giving 
nitroglycerine  the  abnormal  gait  became  less 
and  disappeared  completely  in  twenty-five  days. 
There  was  great  increase  of  body  weight. 
Against  hysteria  major,  mercurial  tremor,  and 
diabetes  mellitus,  this  agent  appeared  quite 
useless. 

»   )    ♦   v^ 

Chloroform  as  an  Emetic  and  Anthelmin- 
tic.— Dr.  G.  W.  Semple,  in  a  paper  read  before 
the  Virginia  Medical  Society,  calls  attention 
to  a  peculiar  emetic  action  of  chloroform  when 
given  in  a  large  dose  by  the  mouth  to  patients, 
with  the  stomach  full  of  ingesta.  In  such  cases 
it  produces  in  from  ten  to  twenty  minutes 
easy  and  copious  emesis,  perfectly  emptying 
the  stomach,  after  which  the  emesis  and  nausea 
cease  entirely.  To  a  coloured  girl,  seventeen 
years  of  age,  who  had  gorged  herself  with  a 
large  melon,  he  gave  two  drachms  of  chloroform 
in  mucilage  of  quillaya.  In  twelve  minutes 
she  vomited,  emptying  the  stomach.  To  a 
child  two  years  of  age,  with  a  stomach  full  of 
damsons,  a  teaspoonful  of  chloroform  was 
given  by  the  mother,  in  a  few  moments  the 
child  vomited,  and  was  greatly  relieved. 

He  also  regards  chloroform  as  an   efficient 

anthelmintic,    using    the    following     formula : 

chloroform  5j,  castor  oil  5J.  croton   oil    gtt.  j. 

Mix.      Dose    5ss.    to   5". —  Virginia    Medical 

Monthly. 

>  <  ♦  M 

From  a  number  of  careful  experiments. 
Professor  Gunning  concluHes  that  inspired  air 
is  freed  from  bacteria  which  may  have  been 
contained  therein ;  and  that  the  expired  air 
does  not  carry  bacteria  along  with  it  out  of 
the  body. 


Salicylic  Treatment  of  Chorea. — Dr.  L. 
S.  Abbott  (Buston  Medical  and  Surgical  Jour- 
nal, December  1st,  1881),  relates  a  case  of 
rheumatic  chorea,  treated  successfully  in  fifteen 
days,  by  salicylate  of  soda.  The  patient  was 
a  housemaid,  aged  25,  who  had  been  recently 
in  the  Hospital  with  acute  rheumatism.  The 
improvement  noticed  while  taking  the  med- 
icine disappeared  during  its  temporary  with- 
drawal, while  rapid  convalesence  followed  its 
resumf»tion.  The  dose  given  was  at  first  ten 
grains  every  two  hours,  afterwards  it  was 
given  every  three  hours,  and  finally  salicin  in 
the  same  dose  was  substituted.  Dr.  Abbott 
refers  to  a  similar  case  reported  by  B.  F.  Gary, 
of  South  Carolina,  and  quoted  in  the  New 
York  Medical  Record,  October  8th,  1881. — 
Birmingham  Medical  Review. 


PiTRES  ON  the  Loss  of  the  Nails  in 
Ataxy.— M.  Pitres  (Ze  Frog.  Med.,  1882,  No. 
8)  refers  to  the  notice  in  M.  Arloing's  recent 
thesis  that  M.  Jofiroy  had  observed  the 
spontaneous  loss,  without  traumatic  cnise,  of 
the  nails  of  the  great  toes  in  an  ataxic  patient, 
and  adds  to  this  two  similar  observations  from 
his  own  practice.  The  nails  were  lost  and 
grew  again  in  each  case  several  times.  The 
occurrence  was  preceded  for  some  weeks  by  a 
dull  pain  and  a  sensation  of  throbbing  in  the 
great  toe.  There  was  no  suppuration  or 
apparent  ulceration  of  the  matrix,  and  the 
nails  were  rapidly  replaced  by  new  ones  of 
normal  conformation. 


Chronic  Rheumatic  Arthritis  in  a  Dog. 
— At  the  Pathological  Society  of  London 
recently,  Dr.  Norman  Moore  exhibited  a 
specimen  showing  bony  outgrowths  on  the 
carpal  and  metacarpal  bones  with  ankylosis. 
The  disease  was  of  long  duration.  The  disease 
probably  caused  great  pain,  and  was,  he  be- 
lieved, one  of  the  commonest  causes  of  the 
howling  of  dogs  at  night.  The  President  (Dr. 
Wilks)  said  that  the  dogs  of  the  Hospice  of 
St.  Bernard,  were  very  subject  to  chronic 
rheumatism,  on  account,  the  monks  believed, 
of  their  exposure  to  cold. 


156 


CANADIAN  JOURNAL 


Artificial  Curare. — At  the  Soci6t6  de 
Biologie,  M.  Raburteau  presented  a  now  com- 
pound, a  white  salt  of  bitter  taste,  soluble  in 
water  and  alcohol,  whose  physical,  chemicah 
and  physiological  propei'ties  are  absolutely 
similar  to  those  of  curare.  Its  chemical  name 
is  methyl-triethyl-stibium  iodide,  whose  for- 
mula is  calculated  on  that  of  ammonium 
iodide.  The  two  formulae  in  fact  correspond. 
Chemically  it  behaves  like  potassium  iodide, 
turns  starch  blue,  and  furnishes  an  oxide. — 
Le  Progres  Medical. 


To  Hasten  the  Action  op  Quinine. — Dr. 
Starke  {Berliner  Klin  Wochenachrijt)  advises 
that  before  swallowing  powder  or  pills  of 
quinine,  a  weak  tartaric  acid  lemonade  be 
taken.  This  procedure  not  only  greatly  accel- 
erates the  solution  and  absorption  of  the 
quinine,  rendering  its  physiological  action 
much  more  prompt,  but  also  obviates  that  un- 
pleasant gastric  irritability  so  common  after 
the  administration  of  large  doses  of  this  drug. 
— Maryland  Medical  Journal. 


Perrin  on  Rheumatic  Purulent  Con- 
junctivitis.— M.  Maurice  Perrin,  in  a  paper 
read  at  the  Academie  de  M6decine  (Le  Journal 
de  Medecine,  1882,  No.  3),  has  drawn  atten 
tion  to  purulent  conjunctivitis  occurring  in 
connection  with  acute  articular  rheumatism, 
and  independent  of  gonorrhoea.  In  two  of 
the  cases  acute  rheumatism  occurred  during 
the  attack  of  conjunctivitis. — Birmingham 
Medical  Review. 


The  German  Mixture  Oleoze,  so  great  a 
favourite  in  disguising  unpleasant  remedies  and 
making  most  compounds  pleasant  to  smell  and 
taste  is  as  follows  :  one  part  each  of  the  oils  of 
lavender,  cloves,  cinnamon,  of  thyme,  citron, 
mace,  and  orange  flowers,  three  parts  balsam  of 
Peru  and  240  parts  of  spirits.  It  is  not  found 
in  any  English,  French,  or  American  work. 
-—Am.  Med.  Weekly. 


c^urocry. 


The  Treatment  of  Diphtheria  by  Papaya. 
— M.  Bouchut  (Le  Progres  Medical,  1882,  No. 
3)  has  found  by  experiment  that  the  false 
membranes  of  croup  dissolve  in  a  few  minutes 
in  papaya  juice.  He  has  used  it  with  success 
to  remove  the  false  membranes  from  the  throat. 
— Birmingliam  Medical  Review. 


FRACTlfRE  OF  THE  PATELLA— THE 
CAUSE  OF  DISPLACEMENT,  AND 
THE  MEANS  OF  REMEDYING  IT. 

In  a  recent  clinical  lecture  at  the  London 
Hospital  {British  Medical  Journal)  Mr.  Jona- 
than Hutchinson  says  :  "  Repeated  observa- 
tions have  convinced  me  that  displacement  is 
always  caused  by,  and  in  proportion  with,  the 
effusion  into  the  joint.  If  there  be  no  efi'usion, 
there  is  no  separation.  The  muscle  is  not  a 
piece  of  India  rubber  to  contract,  and  remain 
contracted  as  soon  as  one  end  is  loosened.  It 
is  as  easily  capable  of  relaxation  as  it  is  of 
contraction,  and,  when  the  limb  is  at  rest,  it  is 
always  relaxed.  When  relaxed  there  is  no 
reason  why  the  upper  fragment  of  the  bone 
should  not  come  easily  down  to  the  other ; 
and,  in  point  of  fact,  in  cases  where  there  is  no 
effusion  it  does  do  so.  I  have  demonstrated 
this  repeatedly."  *  *  *  "The  effusion  may 
be  of  blood,  or  it  may  be  of  synovia,  or,  perhaps, 
most  commonly,  of  a  mixture  of  the  two.  If 
it  occur  immediately  after  the  injury,  then  it 
is  probably  blood ;  and  these  cases  are  the 
most  difficult  to  treat,  for  blood  is  more  slow 
of  absorption  than  synovia.  The  treatment  is, 
however,  the  same  for  both,  and  consists  in  the 
vigorous  use  of  cold,  The  ice-bag  sedulously 
applied,  or  a  spirit  lotion  so  freely  used  thf.t 
evaporation  is  constantly  going  on,  are  the 
best  measures.  You  must  not  be  content 
unless  the  skin  over  the  whole  part  of  the  knee 
be  kept  quite  cold.  It  is  of  great  importance 
that  absorption  should  be  rapid  and  complete. 
If  you  can  get  rid  of  the  swelling  in  eight  or 
ten  days  you  will  have  a  good  chance  of  bony 
union.  I  believe  we  get  bony  union  in  nearly 
half  our  cases.  Our  measures  are,  then,  ice 
for  a  week  or  ten  days  ;  then  oblique  strips  of 
plaster  which  fix  the  fragments  and  catch  in 
notches  in  the  splint."  *  *  #  "The  limb  is, 
of  course,  always  extended  on  a  long  and  bi'oad 
back  splint,  with  a  thick  cushion  and  side 
notches.'  *  *  *  «'  When,  at  the  end  of  ten 
days,  you  have  brought  the  fragments  together, 
cover  the  whole  joint  with  bandages,  and  never 
touch    the    Vjone    again    until   six    weeks   are 


OF  MEDICAL  SClENCk 


lb7 


accomplished."  *  *  *  <«  At  the  end  of  six 
weeks  or  two  months  we  usually  allow  the 
patient  to  get  up,  but  he  is  always  provided 
with  a  patellar  apparatus  before  so  doing,  to 
prevent  flexion  of  the  knee."  *  *  *  «  If  an 
apparatus  be  not  at  hand  a  gum  and  chalk,  or 
plaster  of  Paris  case  will  serve  the  purpose 
quite  as  well.  I  usually  advise  our  patients 
to  wear  the  apparatus  for  six  months ;  and 
then,  if  the  knee  feel  strong,  to  throw  it  aside." 
Mr.  Hutchinson  is  not  an  enthusiast  as  to  the 
advantages  of  bony  union,  and  says  that  those 
who  have  fibrous,  and  even  ligamentous  union, 
often  walk  better.  He  also  points  out  that 
decided  atrophy,  and  sometimes  contraction, 
of  the  quadriceps  follows  not  infrequently. 
Apropos  of  this  Mr.  Christopher  Heath,  of 
University  College,  says  :  "  Agreeing  fully 
with  Mr.  Hutchinson  in  his  view,  I  have 
carried  the  treatment  of  these  cases  further 
than  he  seems  to  have  done,  and  do  not  hesi- 
tate to  aspirate  the  knee-joint  in  cases  both 
of  fractured  patella  and  injury  of  the  joint." 
*  *  *  «  If  the  knee-joint  be  aspirated  within 
a  few  hours  of  the  accident,  the  blood  is  still 
fluid,  and  can  be  readily  withdrawn."  *  ^  * 
"  Having  emptied  the  joint,  or,  still  better^ 
having  the  patient  in  charge  before  efi"usion 
has  taken  place,  I  do  not  hesitate  to  apply  at 
once  plaster  of  Paris  over  an  envelope  of  cotton 
wadding,  and  to  make  the  patient  get  about  as 
soon  as  the  plaster  is  dry."  He  says  in  this 
way  the  muscles  retain  their  tone  and  atrophy 
does  not  ensue.  He  suggests  that  the  I'eason 
why  ligamentous  union  is  often  more  satisfac- 
tory than  a  close  or  bony  union,  is  the  prob- 
ability that  the  patella  contracts  adhesions  to 
the  external  condyle,  thus  limiting  the  motions 

of  the  joint. 

•  ■>■  ■ 

Oakley  on  Complete  Posterior  Disloca- 
tion OF  THE  Knee-joint,  with  Life-long 
Use. — Mr.  J.  Bagnall  Oakley  reports  and 
figures  a  case  of  the  above  injury  in  the  Lancet, 
Jan.,  1882,  p.  63.  The  patient,  aged  70,  when 
seen,  stated  that,  when  nine  months  old  he,  fell 
and  damaged  his  knee-joint,  causing  complete 
posterior  dislocation.  He  has  worked  at  brick- 
making  all  his  life,  and  has  never  beeen  laid 
up  on  account  of  his  knee. — London  Medical 
Record. 


CASE  OF  EXCISION  OF  A  STRIC- 
TURE OF  THE  DESCENDING  CO- 
LON THROUGH  AN  INCISION 
MADE  FOR  A  LEFT  LUMBAR  CO- 
LOTOMY  :  WITH  RE xM ARKS. 

BY  THOMAS  BRYANT,  F.R.C.8. 

Mr.  Bryant  read  the  record  of  a  case  of  stric- 
ture of  the  descending  colon,  in  which  he 
excised  the  diseased  segment  of  bowel  through 
the  wound  made  for  a  left  lumbar  colotomy, 
the  patient  recovering.  The  operation  was 
performed  on  a  lady  aged  50,  who  had  suffered 
from  complete  obstruction  for  eight  weeks,  and 
was  very  feeble.  The  stricture  could  not  be 
felt  from  below.  The  bowei  was  i-emoved 
through  the  oblique  incision  made  for  left 
lumbar  colotomy,  by  simply  pulling  the  segment 
strictured  through  the  wound,  and  stitching 
each  portion  of  the  bowel,  with  its  two^  orifices 
as  divided,  to  the  lips  of  the  wound.  The 
stricture  was  of  the  annular  kind,  and  involved 
about  one  inch  of  the  bowel;  it  was  so  narrow  as 
scarcely  to. admit  the  passage  of  a  No.  8  catheter. 
The  preparation  was  exhibited  with  micro- 
scopical appearances  of  the  growth  in  section, 
as  made  by  Dr.  Goodhart.  Mr.  Bryant  said 
he  believed  the  operation  he  had  performed 
was  a  new  one,  and  that  it  was  applicable  to 
not  a  few  of  the  cases  of  stricture  of  the 
descending  colon.  It  had  suggested  itself  to 
his  mind  from  seeing  cases  of  localised  or 
annular  stricture  of  the  bowel  which  were  free 
and  movable,  both  in  operations  of  colotomy  as 
well  as  in  the  post-mortem  room  ;  but  the  case 
read  was  the  first  in  which  he  had  put  the 
suggestion  into  practice.  He  pointed  out  how 
these  annular  strictures  were  generally  local 
diseases,  and  consequently  how  desirable  it 
was  that  they  should  be  removed  where  pos- 
sible. He  suggested  that  the  question  of  excision 
of  the  diseased  growth  should  be  entertained 
as  soon  as  the  diagnosis  of  the  case  was  made, 
and  that,  in  every  case  of  colotomy  for  chronic 
obstruction  of  the  descending  colon,  the  possi- 
bility of  being  able  to  remove  the  diseased 
bowel  by  operation  should  be  considered  before 
the  bowel  was  opened  for  a  colotomy  opeiation. 
He  then  showed  how  desirable  it  was  that  the 
question  of  excision  or  of  colotomy  should   not 


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CANADIAN  JOURNAL' 


be  postponed  till  the  patient's  powers  were  too 
feeble  to  bear  either,  as  was  too  often  the  case. 
He  stated  that  he  did  not  regard  the  operation 
he  had  performed  in  a  more  serious  light  than 
he  did  a  colotomy  in  which  the  peritoneum  was 
wounded. — Mr.  G.  D.  Pollock  thought  the 
operation  creditable  to  Mr  Bryant;  he  was  not 
aware  of  a  similar  case  in  British  surgery. 
The  history  of  some  cases  of  colotomy  for 
stricture  was  in  favour  of  Mr.  Bryant's  pro- 
posal. He  hoped  that  the  case  recorded  would 
encourage  other  surgeons  in  dealing  with 
similar  cases,  and  in  operating  early. — Mr. 
Harrison  Cripps  referred  to  the  pathology  of 
stricture  of  the  large  intestine,  and  recom- 
mended that,  instead  of  lumbar  colotomy, 
which  afforded  insufficient  room,  an  incisiou 
should  be  made  in  the  front  of  the  abdomen, 
along  the  outer  side  of  the  rectus  muscle.  Mr. 
Howard  Marsh  agreed  with  Mr.  Cripps  in 
recommending  the  anterior  incision,  and  said 
that  cases  in  which  Mr.  Bryant's  operation 
would  be  admissible  were  very  rare.  He 
agreed  with  Mr.  Pollock  that  the  operation 
ought  to  be  pertormed  early. — Mr.  Henry 
Morris  said  in  such  cases  as  that  of  Mr.  Bryant 
the  lumbar  incision  was  preferable;  one  in- 
cision into  the  peritoneum  was  better  than  two. 
British  Medical  Journal. 


Howe  on  a  Lingual  Tourinquet. — This 
instrument  is  described  by  Dr.  Howe  in  the 
Annals  of  Anatoviy  and  Surgery,  Dec.  1881. 
It  is  of  the  shape  of  an  ordinary  safety-pin, 
having  attached  to  the  inside  of  the  external 
bar  a  second  movable  bar,  1^  inches  long, 
worked  by  a  screw  on  the  external  surface. 
To  use  the  same,  the  steel  pin  is  inserted  into 
the  floor  of  the  mouth  opposite  the  second 
molar  tooth,  directed,  at  first,  towards  the 
'median  raphe  of  the  tongue,  then  backwards 
towards  the  foramen  caecum,  and  is  finally 
brought  out  in  front  of  the  anterior  pillar  of 
the  fauces.  The  pin  is  thtn  closed,  and,  by 
using  the  screw,  the  movable  bar  is  made  to 
press  firmly  on  the  trunk  of  the  lingual  artery, 
and  will  control  all  ha;morrhage,  and  permit 
the  artery  to  be  readily  ligatured  when  divided 
in  removal  of  the  tongue. 


TREATMENT     OF    ABSCESS    OF    THE 
LIVER. 

Dr.  Randolph  Winslow:  in  Annals  of  An- 
atomy and  Surgery,  contributes  an  excellent 
article  on  this  subject,  and  closes  his  paper 
with  the  following  conclusions  : 

The  following  summary  represents  the  re- 
sults of  my  investigations  in  regard  to  the 
surgical  treatment  of  abscess  of  the  liver  ; 

1.  The  liver  should  always  be  aspirated  in 
a  case  of  suspected  abscess,  in  order  to  verify 
the  diagnosis. 

2.  Many  small,  and  a  few  large  abscesses, 
have  been  cured  by  one  or  more  aspirations ; 
hence  this  method  should  always  be  employed 
at  the  first  exploration,  and  we  should  then 
wait  until  it  refills.  If  the  pus  collects  slowly 
and  in  small  amounts,  it  may  be  again  aspir- 
ated ;  if  quickly,  and  in  large  quantities,  aspir- 
ation is  not  to  be  relied  upon. 

3.  Incisions  should  be  made  into  the  abscess 
cavity  at  the  most  prominent  portion  of  the 
tumor,  whether  in  an  intercostal  space  or  not ; 
and  irrespective  of  the  presence  or  absence  of 
adhesions. 

4.  Rigid  antiseptic  precautions  add  much  to 
the  safety  and  certainty  of  a  successful  result. 

5.  When  Listerism  is  impracticable,  good 
results  will  be  generally  obtained  by  simple  in- 
cision, or  puncture  by  a  trocar  and  canula, 
followed  by  the  introduction  of  a  drainage  tube, 
and  the  daily  use  of  carbolized  injections. 

6.  Any  of  these  methods  are  preferable  to 
leaving  the  case  to  nature. — Amerioan  Medical 
Weekly. 

THE   EARLY    TREATMENT   OF   PROS- 
TATIC OBSTRUCTION. 

Mr.  Reginald  Harrison,  of  Liverpool, 
strongly  advocates  (^British  Medical  Journal) 
the  early  treatment  of  symptoms  of  prostatic 
obstruction.  He  says  about  one-third  of  all 
men  over  55  years  of  age,  sooner  or  later,  have 
enlargement  of  the  prostate,  and  one-half  of 
these  suffer  therefrom.  There  are  two  con- 
ditions of  enlarged  prostate  not  giving  rise  to 
much  obstruction  :  first,  where  the  hyper- 
trophy is  towards  the  rectum  and  the  relations 
of  the  prostatic  urethra  are  not  altered ;  and, 


OF  MEDICAL  SCIENCE. 


159 


second,  where  the  hypertrophied  gland  is  lobu- 
lated  and  channels  are  left  between  the  masses, 
along  which  urine  flows  without  interruption. 
He  proposes  to  bring  this  condition  about 
artificially  early  in  cases  presenting  signs  of 
commencing  obstruction.  With  this  view  he 
has  "  adopted  a  mode  of  treatment  with 
specially  adapted  bougies.  The  instruments 
are  gum-elastic,  two  to  four  inches  longer  in 
the  stem  than  usual,  with  an  expanded  portion 
an  inch  from  the  tip,  which  is  made  to  enter 
the  bladder.  In  this  way  the  prostatic  urethra 
is  subjected  to  pressure  on  the  insertion  and 
withdrawal  of  the  instrument.  As  a  rule,  if 
dilatation  be  not  too  rapidly  proceeded  with, 
no  irritation  is  aroused.  On  the  contrary 
greater  toleration  of  urine  follows,  owing  to 
the  ease  and  completeness  with  which  the 
bladder  is  then  emptied." 


ANTI-CANCEROUS  DIET. 

Professor  Beneke  of  Marburg,  setting  out 
with  the  notion  that  a  well  nourished  organism, 
rich  in  quarternary  principles  and  phosphates, 
constitutes  a  favourable  soil  for  the  growth  of 
cancer,  suggests  the  following  diet  for  cancerous 
patients,  or  those  who  inherit  a  hereditary 
predisposition  thereto :  — 

Breakfast :  Black  tea,  with  cream  and  sugar  ; 
a  little  bread,  plenty  of  butter ;  baked  potatoes 
with  butter  (cocoa  may  be  substituted  for  the 
tea)  ;  fruit,  fresh  or  cooked ;  biscuits. 

Dinner  :  Soup  of  fruit,  wine,  tapioca  or  peas, 
or  potatoes  ;  not  more  than  two  ounces  of  meat 
(weighed  before  cooking),  potatoes,  vegetable 
roots,  cooked  fruits  ;  apples  and  prunes  with 
rice,  rice  with  rum,  salads,  frait  ices ;  Moselle, 
Rhine  wine.  Champagne ;  very  little  beer 
(because  it  contains  much  alkaline  phosphates). 

Tea :  Black  tea,  with  sugar  and  cream,  a 
little   bread    and    butter,   or    fresh    fruit    and 

biscuits. 

Supper :  Soup  as  at  dinner,  rice  and  fruit, 
baked  potatoes  and  butter,  potato  salad, 
sardines,  anchovies,  herrings ;  corn  flour  gruel 
with  wine  and  sugar  ;  light  wine. — Birmingham 
Medical  Review. 

The  first  German  Medical  Congress  was 
held  at  Wiesbaden,  April  20th  to  22nd. 


Pidivifery. 


TREATMENT  OF  THE  IRRITABLE 
BLADDER  IN  WOMEN. 

BY  J.  H.  ETHERIDGE,  M.D. 

The  cause  of  irritable  bladder  determines  its 
treatment.  When  it  is  unknown,  treatment 
becomes  guesswoi'k.  Consequently  the  physi- 
cian's first  problem  of  treatment  is  the  deter- 
mining of  the  cause  in  each  individual  case  of 
vesical  hypersesthesia. 

Causes  of  irritable  bladder  may  be  divided 
into  intrinsic  and  extrinsic  causes. 

The  intrinsic  causes  include  abnormalities  of 
the  urine,  consisting  of,  first,  too  limpid  urine. 
Second,  too  concentrated  urine.  Third,  an  ex- 
cess of  uric  acid,  as  shown  by  gravel,  calculi, 
and  amorphous  urates.  Fourth,  triple  and 
amorphous  phosphates,  shown  in  decomposition 
of  the  urine.  Fifth,  oxaluria,  and  sixth,  sugar 
and  albumen. 

Among  intrinsic  causes  may  be  included  ab- 
normal substances  not  of  urinary  origin,  which 
may  be  enumerated  as  follows  : 

Seventh,  /)ws  and  blood  from  renal  or  cystic 
diseases.  Eighth,  feculent  matter,  gall  stones, 
joints  of  tape-worms  and  round-worms.  Ninth, 
hair,  fat,  teeth,  and  bones  from  a  fistulous  com- 
muication  with  a  dermoid  cyst. 

Other  intrinsic  causes  include — 

Tenth,  cystitis,  acute  or  chronic.  Eleventh, 
malignant  disease  of  the  bladder,  primary  or 
secondary.  Twelfth,  polypi.  Thirteenth,  cysts 
and  tubercles.  Fourteenth,  hypertrophy,  cen- 
tric or  eccentric. 

Intrinsic  causes  may  include  disorders  of 
the  urethra  as  well  as  of  the  bladder,  and  are 
thus  indicated  : 

Fifteenth,  urethritis,  acute  and  chronic. 
Sixteenth,  neoplasm.  Seventeenth,  dilatation 
of  the  urethra,  including  that  of  the  upper 
third  and  of  the  whole  canal.  Eighteenth,  dis- 
location of  the  urethra.  Nineteenth,  prolapsus 
of  the  urethral  mucous  membrane.  Twentieth, 
stricture  ;  and,  twenty-first,  incomplete  fistula. 

The  extrinsic  causes  of  irritable  bladder  are 
numerous,  often  dif&cult  to  define,  and  are  much 
more  common  than  intrinsic  causes.  Fully 
two-thirds  of  the  cases  of  this  disorder  arise 


160 


CANADIAN  JOURNAL 


from  extrinsic  causes.  '  Presenting  uniformly 
but  the  one  symptom  of  frequent  urination, 
these  causes  are  infinitely  less  correctly  differ- 
entiated by  physicians,  and  consequently  are 
worthy  of  the  closest  scrutiny  and  most  careful 
management,  therapeutic  <lly  and  otherwise. 
Every  experienced  gynaecologist  can  recall  only 
too  many  defeats  in  the  treatment  of  irritable 
bladder  from  extrinsic  causes  because  of  not 
accurately  ascertaining  the  causes  in  each  case- 
The  causes  include  : — 

a.  Oophoria,  or  ovarian,  vascular  excitement. 
b.  Pressure  on  the  bladder  or  urethra  from  the 
uterus,  or  from  rectal  abnormalities,  or  from 
intra-pelvic  tumours,  c.  Sympathetic  irntation 
from  uterine  inflammation.  d.  Malignant 
disease  of  the  cervix  uteri,  e.  Pregnancy,  f. 
Vaginismus.  g.  Acute  pelvic  peritonitis  and 
cellulitis,  h.  A  scar  ides.  i.  Hysteria,  k.  Men- 
tal trouble,  fright.  I.  Exposure  during  men- 
struation, m.  Falls  and  blows  over  the  blad- 
der, n.  Masturbation  and  copulation  ;  and  o. 
Malaria. 

The  causes  herein  mentioned  are  enumerated 
in  extenso,  for  the  purpose  of  showing  that  the 
treatment  cannot  be  the  same  in  all  cases  of 
irritable  bladder. 

The  mangement  of  cases  produced  by  causes, 
usually  involve  remedies  addressed  to  nutrition. 
Too  limpid  urine  suggests  hysteria,  anemia,  ex- 
posure to  cold,  mental  emotion,  in  short, 
diuresis  from  any  cause.  Treatment  of  these 
conditions  involves  remedies  addressed  to  the 
cause  whatever  it  may  be. 

Too  concentrated  urine,  shown  by  the  small 
amount  voided  and  by  high  specific  gravity? 
calls  for  water  simply.  Ordinary  drinking 
water,  Poland  water,  Apollinaris  water,  or 
any  of  the  simple  mineral  waters,  capable  of 
increasing  the  amount  of  water  excreted  by  the 
kidneys  will  answer. 

An  excess  of  uric  acid  is  one  of  the  most 
common  of  all  of  the  many  causes  of  irritable 
bladder.  Neglected,  it  speedily  causes  a  con- 
gestion of  the  mucous  membrane  of  the  bladder, 
and  this,  in  turn,  propagates  the  polyuria  and  dy- 
suria.  The  organic  changes  arising  from  this  con- 
gestion are  of  a  sufficiently  progressive  character 
to  aSbrd  a  constantly  acting  cause  of  irritable 
bladder.     In  this  way,  a  bladder  thus  afflicted, 


at  first,  say,  three  months  ago,  presents  to-day 
an  irritable  condition  arising  from  the  products 
of  chronic  congestion,  whereas  the  excess  of 
iiric  acid  starting  in  motion  this  pathological 
train  of  symptoms  ninety  days  ago,  now  oc- 
cupies a  very  inferior  position  in  the  cause 
today.  Consequently  the  majority  of  cases 
treated  by  physicians  present  not  only  an  ex- 
cess of  uric  acid,  but  they  present  also  a  vesical 
mucous  membrane  congestion.  To  treat  this 
condition  requires  skill  and  patience.  An  ex- 
cess of  uric  acid  indicates  a  systemic,  and, 
especially,  an  alimentary  defect.  This  excre- 
tion, possessed  of  another  particle  of  oxygen, 
becomes  urea  and  ceases  to  be  a  pathological 
product.  To  supply  that  oxygen  is  no  easy 
matter.  If  the  blood  be  made  to  cany  more 
oxygen  and  thus  supply  the  deficiency,  we  must 
give  remedies  to  improve  the  oxygenating 
power  of  the  blood.  For  this  purpose  one 
quarter  to  one  grain  doses  of  permanganate  of 
potash,  thrice  daily,  will  be  found  useful.  This 
powerful  oxydizing  agent  yields  up  its  oxygen 
in  the  form  of  ozone  and  converts  uric  acid  into 
urea.  Irritable  bladder  relieved  by  the  per- 
manganate is  relieved  simply,  not  cured.  The 
alkaline  carbonates  neutralize  uric  acid  excess 
directly,  and  indirectly  diminish  it  by  their 
action  on  the  liver.  The  citrate  or  carbonate 
of  lithium  dissolves  uric  acid,  and  is  a  remedy 
of  undoubted  efficacy.  Colchicum,  in  small 
doses  improves  the  character  of  the  digestive 
ferments  and  promotes  more  perfect  digestion, 
and  in  this  way  supplies  the  liver  with  better 
pabulum,  thus  causing  a  lessening  of  the  amount 
of  uric  acid.  Its  action  is  surprisingly  happy 
in  very  many  cases ;  but  in  many  other  cases 
it  seems  to  extend  the  point  of  tolerance,  caus- 
ing unexpectedly,  a  vomiting  and  violent  purg- 
ing, an  effect  greatly  to  be  deprecated.  Fruit 
acids  are  converted  into  the  alkaline  carbonates 
in  the  blood  and  become  dissolvers  of  uric  acid 
or  diuretics,  and  in  this  way  are  efficient  aids 
in  treating  the  uric  acid  excess.  Many  patients 
will  be"  benefitted  by  a  hot  lemonade  at  bed- 
time, or  by  eating  a  lemon  before  breakfast 
daily,  or  by  partaking  liberally  of  acid  fruit  at 
breakfast  and  lunch  times.  The  uric  acid  ex- 
cess, thus  relieved  can  be  said  to  be  relieved 
only,  not  cured.    It  is  well  to  use  them,  because 


OF  MEDICAL  SCIENCE. 


161 


they  act  quickly  and  satisfactorily.  Thus  re- 
lieved temporarily,  the  physician  can  take  tbe 
necessary  time  to  determine  where  the  ultimate 
cause  of  uric  acid  excess  lies,  and  select  re- 
medies to  cure  it.  The  systemic  defect  is 
usually  the  ultimate  cause  and  will  be  found  in 
the  primary  or  secondary  assimilation.  Con- 
stipation is  almost  always  a  conspicuous  symp- 
tom in  these  cases.  Its  resultant  evils  include 
stomachic  and  intestinal  indigestion.  From  it 
results  a  condition  of  blood  poisoned  with  ex- 
cretory material,  which  causes  all  functions  of 
the  abdominal  organs  to  be  imperfectly  per- 
formed. The  secreting  cells  of  the  liver  fail  to 
elaborate  their  products  perfectly,  and  from 
this  failure  arises  the  uric  acid  excess.  A 
thorough  catharsis  temporarily  relieves  all 
these  symptoms,  and  it  is  an  exceedingly  un- 
wise thing  to  do  to  use  powerful  purges,  because 
they  are  of  only  tempoi'ary  benefit.  The  course 
to  pursue  is  to  give  a  daily  laxative,  and  thus 
by  degrees  purify  the  blood  and  secure  a  sus- 
tained functional  improvement  in  the  organs  of 
primary  assimilation.  To  this  end  the  daily 
use  of  Rakooszy,  Hunyadi  Janos,  Friedrich 
shall,  or  Victoria  mineral  water  in  warm 
weather  ;  or  of  aloes,  podophyllin,  cascara 
sagrada,  compound  extract  of  colocynth,  com- 
pound liquorice  powder,  or  euonymus,  in  cold 
weather,  will  be  useful.  To  improve  the 
secondary  assimilation  we  can  resort  to  the  use 
of  bark  and  iron,  arsenic,  strychnia,  minute 
doses  of  mercury,  when  not  contra-indicated, 
and  cocoa. 

Of  prime  importance  in  these  cases  is 
the  management  of  the  diet.  Farinaceous 
articles  and  acid  fruits  should  be  largely  used, 
and  only  as  much  of  the  albuminous  articles 
used  as  can  be  thoroughly  digested. 

Irritable  bladder  arising  from  triple  and 
amorphous  phosphcUes  should  be  treated  by 
treating  the  systemic  condition  producing  them. 
They  are  usually  found  in  diseases  of  the  nerve 
centres  and  after  great  mental  application. 
They  generally  suggest  the  use  of  rest,  ergot, 
galvanism,  massage,  tonics,  and  improvement  of 
alimentation. 

Oxaluria  should  be  treated  by  paying  especial 
attention  to  the  "  moral,  mental,  and  physica 
condition,   and  time  must  not  be  wasted    in 


treating  a  mere  symptom."  Strychnia  and  the 
mineral  acids  will  yield  the  best  results. 

Cases  involving  diabetes  or  alhu7ninuria  call 
for  treatment  addressed  exclusively  to  these 
conditions. 

Irritable  bladder  arising  from  causes  enu- 
merated, seventh  to  ninth,  inclusive,  must  be 
treated  according  to  indication  wholly,  which 
consists  in  the  removal  from  this  viscus  of 
these  foreign  substances. 

Cases  involving  cystitis,  acute  or  chronic, 
the  tenth  cause  enumerated,  are  troublesome 
enough.  Some  patients  will  make  rapid  re- 
coveries. But  by  far  the  largest  majority  of 
them  will  prove  rebellious.  The  urine  in  these 
cases  must  be  rendered  alkaline  as  speedily  as 
possible.  Citrate  of  potassium,  in  as  large 
doses  as  can  be  borne  without  causing  stomachic 
distress,  is  an  excellent  remedy.  The  removal 
of  existing  constipation  by  daily  laxative  doses 
of  mineral  water  uponarising  in  the  morning,  is 
of  importance,  as  it  secures  a  systemic  condition 
favourable  to  producing  urine  of  minimum 
acidity,  after  which  smaller  doses  of  the  citrate 
of  potassium  will  sufiice  to  produce  alkalinity 
of  the  urine.  At  the  same  time,  restricting 
the  diet  to  articles  calculated  to  aid  in  avoiding 
acid  excess  in  this  excretion,  should  be  pre- 
scribed. An  exclusive  milk  diet  has  cured 
cases  of  long  standing  and  of  great  severity. 
Alkalies,  minim  doses  of  tr.  cantharidis,  hourly, 
twenty  grain  doses  of  bromide  of  ammonium, 
the  solution  of  bromohydric  acid,  benzoate  of 
ammonia  in  buchu,  laxatives,  proper  diet, 
quietude,  will  relieve  most  cases  of  irritable 
bladder  from  acute  cystitis. 

The  irritable  condition  arisirg  from  chronic 
cystitis,  requires  a  wider  range  of  remedial 
measures  to  meet  all  cases.  Many  women, 
however,  are  never  cured,  failure  arising  from 
many  causes,  as  lack  of  pertinacity  on  the 
patient's  part  in  submitting  to  treatment, 
dyscrasia,  failure  to  apprehend  and  to  remove 
coexisting  disorders  which  sympathetically 
propagate  the  cystitis,  etc.,  etc.  Frequent 
urinalyses  are  necessary  to  guide  us  in  the  ad- 
ministration of  medicines,  internally.  Acidity 
is  to  be  modified  or  abolished  by  alkalies.  [Jrin- 
ary  decomposition  calls  for  the  sulpho-carbo- 
I  lates,  for  eucalyptus  globulus  or  tor  salicylate 


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of  sodium.  Medicated  injections  into  the  blad- 
der are  all  important  in  chronic  cystitis.  A 
long  range  of  remedies  is  before  us  to  select 
from.  Antiseptic  injections  include  solutions 
of  common  salt,  potassium  chlorate,  carbolic 
acid,  salicylic  acid,  eucalyptol,  and  the  sulpho- 
carbolates.  Astringent  and  alterative  injec- 
tions embrace  silver  nitrate,  hydrastis  canaden- 
sis, tannic  acid,  plumbic  acetate,  iodoform, 
sulphate  of  zinc,  and  potassic  iodide.  Forcible 
dilatation  ot  the  urethra,  self-retaining  catheter, 
and  cystotomy  are  resorted  to  only  after  other 
means  have  failed. 

Cases  involving  cause  enumerated  eleven, 
will  never  be  relieved  permanently.  Opiates  or 
chloral  may  be  used. 

Polypi  must  be  removed.  No  remedies  can 
be  resorted  to  in  cases  of  too  frequent  urina 
tions  caused  by  polypi. 

Cysts  and  tubercles  are  rare  vesical  troubles 
and  usually  cause  irritable  bladder.  General 
tonics  to  abrogate  the  systemic  condition  pro- 
ducing them,  and  opiates  to  alleviate  the  irrit- 
able condition  seem  to  be  the  remedies  de- 
manded. 

Hypertrophy  of  the  bladder,  a  not  uncommon 
cause  of  dysuria  and  polyuria,  must  have  its 
cause  removed.  Tumours  and  cystocele  must  be 
treated  secundem  artem ;  neuralgia  or  any 
functional  disorder  operating  to  cause  this  con- 
dition, must  be  considered  and  treated  before 
the  irritable  condition  can  be  removed. 

Urethritis,  acute  or  chronic,  is  a  most  trouble- 
some condition  to  remove.  The  acute  form 
generally  calls  for  the  same  sort  of  manage- 
ment accorded  to  gonorrhoea  in  the  male.  The 
subacute  or  chronic  form  calls  for  injections, 
alterative  and  astringent.  The  utmost  pa- 
tience is  necessary  to  cure  cases  of  chronic 
urethritis. 

Neoplasms  demand  surgical  treatment.  The 
general  condition  of  the  patient's  health  can  be 
greatly  improved  by  medication.  Tumours  or 
pressure  in  any  way  retarding  venous  circula- 
tion from  the  pelvis  demands  attention  and  re- 
moval if  possible.  Removal  of  the  neojilasm 
will  relieve  the  patient  of  the  irritable  bladder. 

Cases  involving  causes  numbeiing  from  seven- 
teen to  twenty-one  inclusive,  suggest  their 
remedies,  which  are  surgical  or  mechanical. 


The  treatment  of  cases  of  irritable  bladder 
produced  by  extrinsic  causes  is  included  in  the 
management  of  those  causes.  The  fact  cannot 
be  emphasized  too  much,  and  the  most  trouble- 
some aspect  of  the  treatment  of  irritable  bladder 
in  women  is  the  ascertaining  of  the  cause.  The 
cause  being  determined,  the  principles  of  treat- 
ment are  usually  very  simple. —  WalsKs  Retro- 
spect, 


PRACTICAL  OBSERVATIONS  ON 
OVARIOTOMY. 

BY   DONALD   m'lEAN,    M.D., 

Professor  of  Surgery  and  Clinical  Surgery  in  the 
University  of  Michigan. 

In  this  paper  it  is  my  intention  to  consider 
briefly  certain  practical  matters  in  relation  to 
the  opei-ation  of  ovariotomy. 

First  of  all  1  desire  to  say  that  in  my  opinion 
the  operation  in  question  requires  for  its  suc- 
cessful performance  so  much  surgical  experience 
and  dexterity,  such  carefully-arranged  sur- 
roundings, so  many  appliances,  and  such  perfect 
preparations  in  all  respects  that  its  practice 
should  be  confined  to  a  comparatively  limited 
number  of  surgeons  who  should  be,  in  the 
truest  and  best  sense  of  the  term,  apecialists. 

The  remarkable  success  of  certain  celebrated 
ovariotomists,  has  been  attributed  to  the  cau- 
tious manner  in  which  they  have  selected  their 
cases,  declining  to  operate  whenever  the  diffi- 
culties and  complications  of  the  case  have 
seemed  to  endanger  the  chances  of  success. 

My  own  conviction  is,  that  the  care  and 
thoroughness  with  which  they  prepare  them- 
selves and  their  patients,  in  each  and  every 
instance,  furnishes  the  true  explanation  of  their 
success,  and  I  am  sure  that  their  example  has 
not  been  followed  as  universally  as  it  ought  to 
have  been. 

The  practical  points  which  I  wish  to  refer  to 
more  particularly  at  present  are  the  following : 

(1)  The  anaesthetic  and  its  mode  of  adminis- 
tration. 

(2)  Antiseptics. 

(3)  Treatment  of  the  pedicle. 

(4)  Management  of  adhesions. 

(5)  Drainage  of  the  peritoneal  cavity. 

(1)  The  Ancesthetic. — In  common  with   Dr. 


OF  MEDICAL  SCIENCE. 


163 


Keith  and  others  I  have  'generally  used  ether 
in  this  operation,  but  in  my  later  cases,  chloro- 
form. By  the  use  of  a  very  simple  apparatus, 
I  believe  that  chloroform  may  be  used  in  ovari- 
otomy, and  in  all  other  operations,with  as  much 
safety  and  satisfaction  as  any  other  anaesthetic. 
This  apparatus  consists  of  two  parts  ;  (1)  an 
inhaler  made  by  stitching  a  piece  of  canton 
flannel  over  a  wire  frame  which  fits  like  a  small 
tent  over  the  patient's  nose  and  mouth  j  (2)  a 
dropper  which  consists  of  a  two-ounce  bottle 
with  a  perforated  cork  iind  two  metal  tubes, 
one  of  which  merely  admits  air  to  the  bottle, 
while  the  other  permits  the  chloroform  to  escape 
drop  by  drop.  By  this  means  I  believe  that 
the  greatest  degree  of  safety  is  secured  as  well 
as  the  utmost  economy  of  chloroform. 

(2)  Antiseptics. — In  the  cases  of  ovariotomy 
which  I  saw  Dr.  Keith  perform  he  used  all  the 
Listerian  antiseptic  appliances.  I  could  see, 
however,  that  he  was  beginning  to  doubt  as  to 
its  expediency.  He  assured  me  that  he  had 
seen  patients  die  with  "  brutal  haste "  from 
carbolic  acid  poisoning,  and  I  believe  that 
I  can  say  the  same  myself.  Since  then  (as  is 
now  well  known),  he  has  laid  carbolic  acid 
aside  to  a  great  extent,  if  not  entirely,  and  pre- 
fers to  trust  to  the  careful  arrest  of  haemorrhage 
and  the  thorough  drainage  of  the  peritoneal 
cavity. 

My  own  limited  experience  hardly  justifies  me 
in  expressing  a  decided  opinion  on  this  impor- 
tant point,  but  unless  there  are  special  reasons 
for  doing  so,  I  shall  not  hereafter  resort  to  the 
use  of  carbolic  acid  spray,  against  which  several 
serious  objections  have  been  justly  urged.  My 
belief  is  that  by  exercising  due  care  in  arresting 
haemorrhage,  sponging  out  the  peritoneal 
cavity  till  it  is  absolutely  dry,  and  in  making 
provision  for  the  escape  of  effused  fluids,  the 
danger  of  septicaemia  is  sufficiently  provided 
against. 

Blood  poisoning  has  occurred  in  spite  of  all 
antiseptic  precautions,  and  it  has  been  escaped 
in  cases  not  treated  antiseptically  and  in  which 
the  circumstances  seemed  highly  favorable  to 
its  development. 

(3)  Management  of  Pedicle. — In  my  sixteen 
cases  I  have  transfixed  the  pedicle  with  a 
double    ligature   and    tied    it    in  two    halves, 


cutting  the  ligature  off  short  and  dropping 
the  pedicle  into  the  pelvis. 

So  far  as  I  know,  this  method  of  treating 
the  pedicle  proved  satisfactory.  I  have  never 
seen  any  bad  results  from  this  source.  Never- 
theless, Dr.  Keith's  method  has  seemed  to  me 
to  be,  although  somewhat  slower,  still,  on  the 
whole,  much  more  safe  and  satisfactory. 

He  first  of  all  seizes  the  pedicle  in  one  or 
two  pairs  of  strong  forceps  with  a  catch  in  the 
handle.  If  the  pedicle  is  narrow,  one  pair; 
if  broad,  two,  so  that  the  vessels  are  safely  con- 
trolled for  the  time.  He  then  cuts  away  the 
tumor,  and  then  he  applies  his  clamp  to  the 
pedicle  on  the  cardiac  side  of  the  forceps, 
which  latter  he  then  removes,  leaving  at  least 
one  and  a  half  inches  of  the  pedicle  projecting 
beyond  the  clamp.  To  this  projecting  part  of 
the  pedicle  the  actual  cautery  is  applied  in  the 
form  of  a  solid  mass  of  iron  at  a  black  heat, 
which  slowly  sears  and  shrive's  up  the  tissues 
of  the  pedicle. 

This  part  of  the  procedure  is  conducted 
with  the  utmost  care  and  deliberation,  and 
is  sometimes  the  longest  part  of  the  whole 
operation. 

The  clamp  is- formed  of  two  solid  metallic 
bars,  furnished  with  a  screw,  by  which  they  are 
made  to  compress  the  pedicle  with  great  tight- 
ness. There  are  also  two  wooden  handles  to 
the  clamp,  by  which  the  surgeon  holds  it  in 
his  left  hand  while  he  applies  the  cautery 
with  his  right. 

During  this  part  of  the  operation  the  peri- 
toneal cavity  is  filled  with  soft  sponges,  and 
the  edges  of  the  wound  are  held  in  apposi- 
tion by  the  hands  of  an  assistant.  Between 
the  abdominal  wall  and  the  lower  surface  of 
the  clamp,  a  pad  of  wet  cloth  is  placed  to  en- 
sure its  thorough  protection  from  the  action  of 
the  cautery.  The  pedicle  is  gradually  shrivelled 
up  and  the  debris  wiped  away  until  all  the 
pedicle  external  to  the  clamp  is  disposed  of. 
The  latter  is  then  unscrewed  and  removed 
while  the  surgeon  takes  care  to  retain  control 
of  the  remainder  of  the  pedicle  until  he  has 
carefully  examined  it  and  satisfied  himself  that 
there  is  no  tendency  to  bleeding.  If  there  is 
any  doubt  on  this  point  the  pedicle  should  be 
transfixed  a«d  securely  tied,  either  with  strong 


164 


CANADIAN  JOURNAL 


catgut,  or  a  silk  ligature.  A 11  danger  of  haemorr- 
hage being  in  one  way  or  the  other  £;uarded 
against,  the  pedicle  is  permitted  to  subside  into 
the  pelvic  cavity. 

(4)  Treatinerd  of  Adhesions. — The  only  point 
I  wish  to  note  on  this  part  of  the  subject  is  the 
vital  importance  of  securing  every  point  that 
shows  the  slightest  inclination  to  bleed.  Much 
patience  and  perseverance  are  sometimes  re- 
quired for  this  part  of  the  operation,  but  it  is 
impossible  to  over-estimate  its  urgent  neces- 
sity. The  best  ligatures  to  use  in  this  situa- 
tion are  those  made  of  carbolized  catgut. 
They  are,  of  course,  cut  off  close  to  the 
knot. 

(5)  Drainage  of  the  Peritoneal  Cavity. — The 
only  method  of  drainage  now  resorted  to  is  that 
by  means  of  a  glass  tube,  the  lower  end  of  which 
rests  in  Douglas's  cul  de  sac,  while  the  other 
projects  through  the  lower  end  of  the  wound 
in  the  abdominal  wall. 

The  drainage  tube  may  often  be  dispensed 
with,  and  the  operator  will  always  be  glad  to 
omit  its  use  when  he  feels  that  he  can  do  so 
with  safety.  In  cases  where  there  is  any 
prospect  of  extensive  effusion,  especially  if 
there  is  reason  to  fear  oozing  of  blood,  the 
drainage  tube  is  indispensable.  It  was  first  used 
by  the  late  Professor  Peaslee,  but  at  least  one 
fundamental  alteration  has  recently  been  made 
in  his  method  of  using  it.  Peaslee  kept  a  plug 
of  carbolized  cotton  in  the  mouth  of  the  tube, 
and  he  removed  this  from  time  to  time  and 
allowed  the  accumulated  effusions  to  escape. 
Now  the  effusions  are  not  permitted  to  accu- 
mulate, the  mouth  of  the  tube  is  always  kept 
free,  and  the  effusions  are  provided  for  by  the 
application  of  a  large  soft  carbolized  sponge 
over  the  end  of  the  tube.  The  sponge  is  en- 
veloped in  a  sheet  of  rubber  cloth  which  hat  a 
hole  in  its  centre  through  which  the  end  of  the 
drainage  tube  projects.  The  fluids  are  thus 
caught  in  the  sponge,  and  at  stated  intervals 
the  nurse  unfolds  the  rubber  sheeting  and  re- 
places the  saturated  sponge  with  a  clean  one. 
In  this  way  the  fluids  are  got  rid  of  as  soon 
as  secreted,  and  at  the  same  time  their  quality 
and  constitution  afford  valuable  information  to 
the  surgeon.  Just  as  soon  as  all  appearance  of 
effusion  has  ceased  the  tube  may  be  removed 


and  the  opening  closed  with  a  hare-lip  suture. 
This  will  sometimes  occur  as  early  as  the 
fourth  or  fifth  day. 

If  the  discharge  from  the  tube  presents  any 
signs  of  becoming  purulent  the  peritoneal  cavity 
may  be  washed  out  with  a  v.reak  solution  of 
carbolic  acid  and  common  salt,  a  drop  or  two 
of  the  former  and  five  grains  of  the  latter  to 
a  pint  of  water  at  a  temperature  of  lOOo 
Fahrenheit.  This  is  an  expedient  which,  in 
my  experience,  never  fails  to  afford  material 
relief  and  comfort  to  the  patient. —  Walsh's 
Retrospect. 


EMMET'S    OPERATION    FOR  LACERA- 
TION OF  THE  CERVIX. 

At  a  meeting  of  the  Obstetrical  Society,  of 
London,  March  1st,  the  President,  J.  Matthews 
Duncan,  in  the  chair.  Dr.  W.  S.  Playfair  read 
a  paper  on  the  above  subject,  in  which  he  spoke 
very  favourably  of  the  operation,  and  paid  a  high 
tribute  to  Dr.  Emmet  for  introducing  such  a 
great  improvement  in  gynaecology.  In  a  some- 
what lengthy  discussion  which  followed,  some 
spoke  rather  disparagingly  about  the  so-called 
improvement,  others  gave  it  faint  praise,  and  a 
few  (notably  the  President  and  Dr.  Sharp) 
exhibited  a  lamentable  and  inexcusable  ignor- 
ance of  the  subject  which  appears  very  remark- 
able to  us  on  this  Continent.  We  have  a  right 
to  expect  that  men  so  distinguished,  and  holding 
such  high  positions  in  the  medical  world,  as  the 
gynsecologists  referred  to,  should,  before  dis- 
cussing an  operation  of  such  importance,  attain 
an  exact  knowledge  of  what  they  are  talking 
about. 

Dr.  Savage  {British  Medical  Journal),  said 
Dr.  Playfair  proceeded  on  principles  directly 
opposed  to  those  of  Dr.  Emmet,  who  insisted 
that  the  operation  should  not  be  performed 
when  there  was  any  sign  of  disease  in  the 
cervix.  The  American  School  professed  to  be- 
lieve that  every  disease  (none  excluded)  inci- 
dental to  the  uterus  might  be,  and  generally 
was,  the  direct  consequence  of  a  cervical  lacera- 
tion. The  English  School  disbelieved  this  on 
good  grounds.  The  diseases  alluded  to  in  Dr. 
Playfair's  paper  could  be  seen  in  their  entirety 
through  an  ordinary  Ferguson's  speculum.     To 


OF  MEDICAL  SCIENCE. 


166 


apply  to  them  Emmet's  operation,  which  was 
admittedly  not  seldom  followed  by  pelvic  mis- 
chief, would  be  an  act  of  extreme  folly.  En- 
tropion, not  ectropion,  according  to  Emmet, 
was  the  common  result  of  the  lacerations. 

After  several  members  had  expressed  their 
opinions  on  the  subject,  the  President  said 
he  could  not  concur  in  thinking  tracheloraphy 
one  of  the  greatest  advances  in  modern  gynaeco- 
logy. It  might  be  an  advance,  but,  admitting 
all  that  was  said  about  it,  it  was  a  very  small 
affair,  compared  with  the  triumphs  of  laparo- 
tomy, shown  by  Dr.Bantock,  and  Mr.  Thornton. 
A  split  condition  of  the  cervix  was  said  to  be 
attended  with  Protean  symptoms  and  disorders. 
Not  long  ago,  ulcerations,  and  then  displace- 
ments, held  the  same  position.  He  regarded  all 
three  as  minor  disorders,  whose  attempted  cure 
was  often  the  worst  part  of  them.  The  Protean 
disorders  were  accompaniments,  not  conse- 
quences. Nevertheless,  the  cure  of  such  lesions 
might  be  a  valuable  service  to  the  patient. 
An  ectropion  which  could  only  be  shown  by  a 
special  speculum,  and  special  manipulations 
was  an  artificial  ectropion.  He  did  not  regard 
the  profession  as  having  hitherto  mistaken 
ectropion  for  so-called  ulceration.  Such  cases, 
with,  or  without  ectropion,  were  generally 
easily  cured.  In  cases  with  hypertrophy  a 
good  old  plan  was  the  caustic  potass.  He  be- 
lieved that,  if  a  new  laceration  were  made  by 
cutting  out  a  bit  of  the  cervix,  cure  would  fol- 
low just  as  well  as  after  tracheloraphy.  The 
reference  to  the  frequency  with  which  the 
cervix  was  formerly  divided  as  a  means  of  cure 
was  not  SLJeu  d' esprit,  but  a  weighty  argument. 
He  regarded  tracheloraphy  as  at  present  sub 
jvdice,  but  was  not  impressed  in  its  favour.  He 
had  not  done  it,  but  had  seen  the  most  exag- 
gerated lacerations  of  the  cervix  interfere  in 
no  degree  with  health,  comfort,  or  fertility. 

Dr.  Playfair,  in  closing  the  discussion,  said 
he  had  carefully  studied  the  writings  of  Thomas 
and  Emmet,  and  thought  that  Dr.  Sharp  must 
have  misunderstood  their  meaning.  It  was 
impossible  not  to  see  that  Dr.  Matthews  Dun- 
can was  prejudiced  against  the  operation ;  his  re- 
marks showed  that  he  was  not  familiar  with  the 
use  ot  the  duck-bill  speculum  and  tenaculum  in 
these  cases.    The  tenaculum  was  not  used  to  pro- 


duce ectropion,  but  to  draw  the  lips  together.  He 
thought  that  when  Dr.  Duncan  had  fairly  and 
impartially  studied  the  subject,  he  would  alter  his 
opinion.  This  operation  was,  of  course,  not  to 
be  compared  with  those  to  which  Dr.  Duncan 
had  referred  ;  but,  if  it  were  the  fact  that  there 
were  hundreds  of  women  leading  lives  of  con- 
stant suffering,  who  might  be  cured  by  this  opera 
tion,  then  it  deserved  to  be  called  a  great  im- 
provement in  gynaecology. 


Barnes  on  Antiseptic  Midwifery. — Dr. 
Barnes  states  that  antiseptic  treatment  should 
be  begun  early.  Indeed,  with  the  conclusion  of 
labour,  the  first  great  point  is  to  secure  firm 
contraction  of  the  uterus.  The  pad  and  binder 
are  useful.  The  compression  exerted  upon  the 
abdomen  and  pelvis  not  only  tends  to  promote 
uterine  contraction,  but  it  counteracts  the  aspi- 
ration or  suction-force  which  tends  to  draw  air, 
one  of  the  factors  of  decomposition  into  the 
uterus.  It  opposes  centripetal  osmosis.  The 
day  after  labour,  it  is  useful  to  give  an  aperient. 
It  commonly  happens  that  in  the  effortof  defeca- 
tion, the  uterus,  compressed  and  sharing  in  the 
diastaltic  action,  expels  a  clot.  It  then  con- 
tracts more  effectually.  The  maintenance  of 
contraction  is  efficiently  aided  by  the  action  of 
oxytocics.  Dr.  Barnes  always  gives  after  every 
labour  a  mixture  of  quinine,  ergot,  and  digitalis, 
three  times  daily,  continued  for  two  or  three 
weeks.  The  effect  in  contracting  the  uterus  is 
remarkable.  It  is  shutting  the  gate  in  the 
face  of  the  enemy.  The  next  thing  is  to  wash 
out  the  uterus.  Plain  tepid  water  may  serve 
the  purpose,  but  a  solution  of  carbolic  acid* 
1  in  50,  is  better.  This  should  be  done  once 
or  twice  a  day  from  the  second  day.  On  the 
first  day,  there  is  little  risk  of  absorption. 
Should  there  be  the  slightest  rise  of  tempera- 
ture and  pulse,  this  intra-uterine  injection  is 
imperative.  We  ought  not  to  refer  to  intra- 
uterine injections  without  reference  to  Harvey 
the  Immortal,  who  thus  cured  a  lady  in  immi- 
nent danger  of  septicaemia.  Carbolic  solution 
should  be  kept  in  the  room.  The  catheter 
should  be  kept  in  it.  If  s|)onges  are  used  they 
should  be  kept  in  the  solution.  It  is  probable 
that  sulphurous  acid  may  be  found  even  better 
than  carbolic  acid  as  an  antiseptic.       Durochet, 


166 


CANADIAN  JOURNAL 


in  his  investigations  on  osmosis,  found  that 
the  slightest  trace  of  sulphurous  acid  stopped 
osmosis.  It  may  be  used  in  the  proportion  of 
1  in  40.  Whilst  taking  care  to  exclude  foul 
stuff  fr<'m  the  genital  canal,  we  must  be  careful 
to  exclude  foul  air  from  the  lungs  and  skin. 
When  the  sun  shines,  open  the  windows.  At 
night,  especially,  a  fire  is  often  the  condition 
of  good  ventilation.  It  is  of  the  utmost  im- 
portance to  guard  against  chill  or  any  check 
upon  the  due  action  of  the  skin,  lungs,  kidneys, 
and  intestinal  canal ;  that  is,  maintain  in  due 
working  order  the  excretory  organs.  Dr. 
Goodell  has  insisted  upon  the  draining  of  the 
uterus  as  a  means  of  getting  rid  of  noxious  stuff. 
The  principle  is  admirable.  There  is  no  doubt 
that,  in  the  ordinary  recumbent  posture,  blood 
and  discharges  are  apt  to  collect  in  the  lax 
uterus  and  vagina.  Dr.  Goodell  recommends 
that  the  patient  should  at  times  be  raised  into 
the  sitting  posture  to  allow  the  fluid  to  drain 
off.  Where  a  woman  is  strong,  and  after  a 
few  days,  this  plan  may,  perhaps,  be  adopted 
without  disadvantage;  but  in  the  weakly  sub- 
jects most  prone  to  septicaemia,  especially  after 
haemorrhage,  sitting  up  has  been  followed  by 
syncope  and  sudden  death.  If  firm  pressure 
be  maintained  upon  the  hypogastrium,  and 
antiseptic  irrigations  be  duly  observed,  drainage 
is  secured.  At  the  same  time  if  the  bed  be 
properly  made,  so  that  the  head  and  shoulders 
are  kept  at  a  slightly  higher  level  than  the 
pelvis,  drainage  will  be  fairly  accomplished. 
The  dorsal  decubitus  is  more  favourable  to 
drainage  than  the  lateral.  An  effective  barrier 
against  the  ingestion  of  noxious  stuff  from  the 
parturient  canal,  is  to  supply  the  system  with 
healthy  nutriment  by  the  stomach.  The  more 
the  system  is  supplied  in  this  way,  the  less  will 
it  absorb  from  vicious  sources.  Dr.  Oldham 
was  one  of  the  first  to  lead  the  revolt  against 
the  old  fashion  of  starving  on  gruel  during  the 
first  week ;  but  it  is  easy  to  err  in  reaction. 
During  the  first  two  day.s,  the  system  craves 
rest  as  well  as  food.  Food  'that  is  not  easily 
assimilable  is  apt  to  load  the  stomach,  lying 
undigested  or  badly  digested.  As  regards  anti- 
septic midwifery  in  lying-in  hospitals,  the 
dangers  gather  round  the  patient  in  an  ac- 
celerating ratio.     If  the  history  of  many  lying- 


in  hospitals  could  be  fairly  written,  we  should 
have  a  terrible  record  of  lives  sacrificed  to 
ignorance,  to  reckless  disregard  of  medical 
authority,  to  architectural  folly,  to  maladminis- 
tration, to  scandalous  experimentation  of  fanci- 
ful crotchets.  •  XJnreformed  benevolence,  over- 
riding the  practical  benevolence  of  science,  has 
always  been  prolific  of  disaster.  Nowhere  can 
it  count  more  victims  than  in  lying-in  hospitals. 
The  first  imperative  condition  for  the  safety  of 
women  in  lying-in  hospitals  is  the  absolute 
single  authority  of  the  physician.  The  descrip- 
tion given  by  Dr.  Fancourt  Barnes  of  the  system 
in  force  at  theBritish  Lying-in  Hospital  is  a 
practical  illustration  of  the  rules  necessary  to 
secure  safety.  Every  patient  is  delivered  under 
the  carbolic  spray.  This  disinfects  nurses  and 
pupils  who  are  assisting,  and  prevents  the 
entrance  of  germs  or  foul  matter  into  the 
genital  track,  atthe  moment  when  it  is  distended 
and  opened  by  the  passage  of  the  child.  All 
washings,  syringings,  and  examinations,  are 
done  with  carbolic  solution.  Carbolic  spray  of 
1  in  80  is  almost  continually  playing  in  each 
ward.  To  secure  contraction  of  the  uterus, 
each  patient  has  a  mixture  of  quinine,  ergot, 
and  opium,  three  times  a  day,  for  the  first 
week.  Since  instituting  the  above  practice,  he 
rarely  finds  any  rise  of  temperature  during  the 
lying-in.  We  may  thus  hope  to  see  the  day  when 
women  can  be  delivered  in  lying-in  hospitals  as 
safely  as  in  home  practice. — London  Medical 
Record. 


Nitrite  of  Amyl  as  an  Antidote  for 
Strychnia,  and  for  Subduing  Puerperal 
Convulsions. — In  noticing  the  experiments  of 
Messrs.  Greville  Williams,  and  Waters,  on  the 
antidotal  action  of  "  /?  lutidine,"  Dr.  Robert 
Barnes,  of  St.  George's  Hospital,  relates  a  case 
of  strychnine  poisoning.  The  administration  of 
amyl  nitrite  by  inhalation,  whenever  the  twitch- 
ing or  facial  expression  indicated  the  onset  of 
spasm,  during  sixteen  hours  carried  the  case 
to  a  successful  termination.  He  also  says  he 
has  saved  several  lives  by  utilising  its  spasm- 
subduing  virtues  in  cases  of  Puerperal  Con- 
vulsions, and  regards  it  in  such  cases  superior 
to  chloroform. 


OP  MEDICAL  SCIENCE. 


16T 


HOUR  GLASS  CONTRACTION  OF  THE 
UTERUS  TREATED  WITH  NITRITE 
OF  AMYL. 

In  the  British  MedicalJournal  for  the  18th 
March,  Dr.  Farncourt  Barnes,  Physician  to  the 
British  Lying-in-Hospital,  relates  a  case  of 
spasm  of  the  os  internum  and  Bandl's  ring  in- 
duced by  the  administration  of  ergot  immedi- 
ately after  the  birth  of  a  child,  and  preventing 
the  delivery  of  the  placenta.  Three  drops  of 
nitrite  of  arayl  were  administered  by  inhalation 
from  a  handkerchief,  the  spasm  at  once  relaxed 
and  delivery  of  the  after-birth  was  readily 
effected.  He  quotes  from  the  3rd  edition  of 
Dr,  Robert  Barnes'  work  on  Obstetric  Opera- 
tions. "  We  possess  in  ergot  a  great  and 
dangerous  power  of  augmenting  the  force  of 
the  uterus.  We  want  an  agent  endowed  with 
the  opposite  effect,  that  will  control  and  sup- 
pi-ess  uterine  action.  I  consulted  Dr.  Richard- 
son on  this  point.  He  tells  me  the  desired 
power  exists  in  the  nitrite  of  amyl.  Three 
minims  of  this  added  to  one  drachm  of  ether 
taken  by  inhalation  is  the  form  he  recommends. 
It  does  not  produce  unconsciousness ;  but  it  is 
an  anaesthetic  as  well  as  a  sedative  of  muscular 
action'.  It  is  the  antidote  or  opposite  force  to 
ergot.  In  it  we  have  the  desiderated  *  epechon- 
tocic  agent.'  "  It  is  claimed  that  this  is  the 
first  case  of  the  practical  application  of  this 
power. 


Blis'^rs  in  Young  Children. — M.  Arch- 
ambault  (Journal  de  Med.  et  de  Chir.  prat., 
Jan.  1882,  p.  14.)  points  out  that  blisters 
should  not  be  used  as  routine  treatment  in 
children,  as  they  are  always  painful  and  often 
harmful.  In  a  child  of  a  year  old,  the  blister 
should  not  be  left  on  longer  than  one  hour ;  at 
four  or  five  years,  four  hours  is  enough.  The 
blister  should  be  covered  with  a  piece  of  oiled 
silk  paper.  Blisters  should  never  be  applied 
to  cachectic  children  or  to  those  with  a  tendency 
to  skin  eruptions ;  but  above  all,  blisters 
should  be  avoided  in  diphtheria  and  croup,  and 
at  the  terminations  of  scarlatina,  measles,  &c., 
as  he  has  often  seen  extensive  ulcers  so  caused. 
Blisters  should  not  be  applied  posteriorly  or  to 
parts  exposed  to  pressure. — Birmingham  Med- 
ical Review. 


Procidentia  of  Gravid  Uterus. — In  con- 
nection with  the  very  interebting  case  of  this 
kind,  published  by  Dr.  Ross  in  our  present 
issue,  we  would  draw  the  attention  of  our 
readers  to  the  case  published  by  Dr.  Percy 
Boulton  in  the  British  Medical  Journal  for 
11th  March  last,  in  which  the  womb  became 
procident  between  the  3rd  and  4th  month  of 
gestation,  and  eould  not  be  returned.  "  The 
foetus  was  carried  to  full  term  in  the  prolapsed 
uterus,  "  which  reached  down  to  the  ham- 
strings," and  was  not  unlike  a  cow's  udder. 
Dr.  Lowe,  of  Lynn,  attended  the  patient, 
and  saw  the  foetus  and  placenta  pass  straight 
from  the  uterus,  without,  of  course,  travers- 
ing the  pelvis.  The  labour  was  short,  easy, 
and  quick."  Dr.  Boulton  suggests  the  possi- 
bility of  producing  artificial  prolapse  in  certain 
cases  as  an  alternative  for  craniotomy. 


PREtENTION  OF  LACERATION  OF  PERINEUM. 

Dr.  G.  Hurd  of  St.  Louis,  Mo.,  holds  that  a 
sharply  flexed  and  abducted  condition  of  t^e 
thighs  jeopardizes  the  safety  of  the  perineum, 
during  the  passage  of  the  child's  head,  and 
relates  cases  {St.  Louis  Med.  and  Surg.  Jl.) 
in  which  rupture  was  apparently  averted  by 
extension  of  the  mother's  leg  at  the  moment  of 
perineal  distension  by  the  child's  head. 

To  the  Editor  of  the  Canadian  Journal  of  Mksical  Sciknci. 

Dear  Sir, — I  observe,  in  the  last  issue  of  the 
Canada  Lancet,  an  article  upon  the  recently 
constituted  Ontario  Board  of  Health,  to  which, 
with  your  permission,  I  desire  briefly  to  refer. 

I  heartily  join  in  the  congratulations  of  the 
Lancet  upon  the  fact  that  a  step  has  been  taken 
in  the  direction  of  progress,  and  that  a  Board 
of  Health  for  Ontario  has  been  established. 
We  are  all  agreed  as  to  the  desirability  of  the 
measure,  and  are  willing  to  acknowledge  our 
indebtedness  to  the  Government  of  the  Pro- 
vince tor  the  inauguration  of  legislation  which, 
amplified,  as  it  must  be,  under  more  enlightened 
views,  will  prove  to  be  a  great  public  benefit 
For  myself,  as  an  entirely  disinterested  on- 
looker, I  have  only  one  regret  to  express.     A 


168 


CANADIAN  JOURNAL 


work  such  as  that  contemplated  by  the  Act 
requires,  for  anything  like  complete  success,  at 
least  one  medical  officer  who  would  be  prepared 
to  devote  all  his  time  to  the  duties  of  his  office. 
I  venture  the  assertion  that  all  the  provisions 
of  the  Bill,  even  in  its  present  shape,  cannot  be 
adequately  met  unless  a  secretary  can  be  suffi- 
ciently remunerated  to  be  satisfied  to  relinquish 
all  other  professional  work.  If  this  Board  of 
Health  is  to  accomplish  a  work  whose  beneficial 
eflects  will  be  as  wide-spread  as  the  limits  of 
this  Province  itself,  it  will  not  do  for  the  active 
officer  of  the  Board  to  confine  himself  to  the 
working  out  of  only  such  details  as  he  can 
manage  without  leaving  the  City  of  Toronto. 
He  should  be  a  man  possessed  of  the  ability  to 
acquire  a  thorough  acquaintance  with  all  the 
various  expedients  that  will  tend  to  give  effec- 
tiveness to  the  measure.  Then  he  should  have 
the  authority  to  spend  a  large  share  of  his  time 
each  year  in  visiting  the  various  parts  of  the 
country,  and  presenting  such  information  as  will 
enlighten  the  general  public  upon  all  the  im- 
portant points  that  will  naturally  engage  the 
attention  of  the  Board. 

With  the  present  composition  of  the  Board 
I  am  not  inclined  to  find  fault.  It  will  be 
readily  seen  that,  with  the  diverse  and  some- 
what antagonistic  elements  that  have  been  per- 
mitted to  obtain  in  this  Province,  through  pre- 
vious medical  legislation,  a  work  of  making  a 
judicious,  and  at  the  same  time  a  satisfactory 
selection  has  been  no  easy  task.  To  my  own 
mind,  then,  a  difficult  work  has  been  accom- 
plished with  a  fair  regard  to  the  qualifications 
necessary  for  such  a  position,  and  the  various 
interests  involved. 

But  your  big  brother  of  the  Lancet  could  not 
wind  up  his  otherwise  fairly  good  article  with. 
out  his  customary  ill-natured  allusion  to  the 
Chairman  of  the  Board  and  his  want  of  qualifi. 
cation  for  that  position,  I  know  of  no  more 
contemptibly  mean  man  than  he  who,  having 
the  almost  unlimited  power  which  he  wields 
through  his  own  Journal,  utilizes  it  by  making 
a  nasty  personal  attack  upon  his  professional 
brother  who  happens,  for  the  time  being,  to 
have  been  only  a  rival.  Now,  this  is  precisely 
the  position  of  matters  as  between  the  Editor 
of  the  Lancet  and   Dr.   Oldright.     They  both 


happened  to  be  applicants  for  this  position. 
Judicious  counsels  prevailed  in  the  present  in- 
stance, the  almost  infinitely  superior  man  of 
the  two  received  the  appointment  ;  and  the 
sorehead,  with  a  degree  of  presumption  which, 
I  venture  to  say,  could  only  find  expression  in 
the  Editor  of  the  Lancet,  vents  his  malicious 
spleen  upon  his  competitor  in  the  contest  by  an 
unfounded  reference  to  his  incompetence  which 
will  not  find  an  endorsation  from  a  solitary  in- 
dividual acquainted  with  the  character  and 
attainments  of  both  men.  Will  the  Editor  of 
the  Lancet  kindly  inform  your  correspondent  as 
to  the  grounds  upon  which  he  has  been  pleased 
to  characterize  the  recently-appointed  Chair- 
man of  the  Board  of  Health  as  a  "  mere 
theorist,"  arid  so  incompetent  for  the  position 
as  to  materially  jeopardize  the  chances  of  its 
usefulness  1  I  have  no  doubt  he  is  expressing 
his  true  inwardness  when  he  volunteers  the 
able  suggestion,  "  the  selection  of  the  Chairman 
does  not  meet  with  our  approval."  No  one  ever 
supposed  for  a  moment  that  any  other  appoint- 
ment than  that  of  Dr.  Fulton,  would  meet  the 
approval  of  the  distinguished,  eminently  prac- 
tical Editor  of  the  Lancet.  Dr.  Oldright  needs 
no  defence  among  his  professional  brethr'en  in 
Toronto ;  and  I  should  not  have  felt  it  neces- 
sary to  utter  a  sentence  in  his  behalf,  but  for 
the  possible  effect  of  this  scurrilous  article 
where  he  is  not  so  well  known  to  the  profession, 
and  the  feeling  of  distrust  it  may  arouse  in  the 
minds  of  some  as  to  the  ultimate  success  of  the 
measure.  He  has  now  been  pursuing  his  pro- 
fession for  some  sixteen  years  and  with  a  degree 
of  success  in  all  directions  that  will  not  only 
bear  favourable  comparison  with  that  of  the 
Editor  of  the  Lancet,  but  can  be  demonstrated 
to  be  far  superior.  In  addition  to  this,  it  is 
only  just  to  him  to  say  that  the  special  direc- 
tion which  his  labours  have  taken  for  the  last 
nine  years  has  been  such  as  to  eminently 
qualify  him  for  a  career  of  great  usefulness  in 
the  sphere  to  which  he  has  been  recently  ap- 
pointed. If  the  Government  could  have  seen 
their  way  clearly  to  offering  sufficient  induce- 
ments to  one  professional  officer  to  encourage 
him  to  abandon  regular  professional  work.  Dr. 
Oldright  is,  in  my  humble  judgement,  one  of 
the  best  men    eligible  to-day  for  the  appoint- 


OF  MEDICAL  SCIENCE. 


169 


ment.  If  he  is  anything,  he  is  a  most  decidedly 
practical  man.  That  he  is  practical  needs  no 
better  evidence  than  the  fact  that  he  has  proved 
himself  to  be  a  successful  practitioner. 

' '  Oh,  wad  some  power  the  giftie  gie  us, 
To  see  oorsels  as  ithers  see  us, 
It  wad  frae  mony  a  blunder  free  us, 
And  foolish  notion  !  " 

1  commend  the  above  suggestive  lines  of  Scot- 
land's noblest  bard  to  the  earnest  consideration 
of  the  Lancet,  with  the  strongest  assurance 
that  the  steady  adoption  of  the  principle  so 
quaintly,  but  beautifully,  expressed,  would 
prove  to  him  and  to  all  of  us  a  valuable  guide 
to  future  action. 

What  a  pity  that  men  of  culture  should  be 
so  absorbed  in  self,  that  they  cannot  see  any- 
thing in  their  neighbours  but  inaptitude  and 
imperfection,  while  they  are  continually  behav- 
ing in  a  way  which  indicates  that  their  own  im- 
pression is  that,  without  their  individuality  the 
world  would  be  a  vast  howling  wilderness  !  The 
Editor  of  the  Lancet,  as  often  as  opportunity 
offers,  and  somewhat  oftener,   while  he  is  un- 
scrupulous upon  some  points  of  medical  ethics 
himself,  does  not  hesitate  to  hold  up  to  public 
derision,    and    scandalize    every    professional 
brother  who  crosses  his  path,  even  though  it  be 
only  in  honourable  rivalry.   This  may  be  pardon- 
able in  the  political  arena,  or  among  those  who 
are  recognised  as  pot-house  politicians,  but  it  is 
decidedly  beneath  the  dignity  of  a  member  of 
the  noble  profession  to  which  we  belong,  and 
I  would  fain  hope  there  are   few  of  us  who 
would  descend  to  the  methods   systematically 
adopted  by  the  Lancet,  in  order  to  bring  dis- 
credit upon  our  professional  brethren. 

Yours  very  truly, 

Junius. 


To  the  Editor  of  the  Canadian  Journal  of  Mbdical  Scibncr. 

Sir, — Since  the  editorial  concerning  con- 
sultation with  Homoeopaths  appeared  in  your 
columns,  and  since  the  Lancet  took  up  the 
gauntlet  in  behalf  of  the  Homoeopaths,  .no 
less  than  three  different  occasions  have  been 
brought  to  my  notice,  upon  which  the  promi- 
nant  medical  man  of  this  city,  mentioned  by 
you,  has  met  homoeopathic  physicians  in  con- 
sultation. Upon  each  of  these  three  occasions 
he  was  called  upon  to  sew  up  ruptured  perinsea 


(a  fact  which  speaks  highly  of  the  homoeopathic 
obstetric  procedure.)      Formerly  I  had   been 
unwilling    to    believe   it    possible    that   such 
rumours    could    actually    be    true,     but    the 
opinion    lately    expressed  in   the   recent  edi- 
torial of  the  Lancet  upon  this  subject,  renders 
it  too  probable  that    the  stories  are   at  least 
founded  on  fact.      And  the  sorrowful  spectacle 
is  presented  to  us  of  a  teacher,  an  aspirant  to 
surgical   fame    and   one    who    seeks   to    be    a 
leader  of  medical    thought    in   this    province, 
openly  casting  aside  the  wise  restraints  imposed 
upon  us  by  our   code   of  medical   ethics  and 
endeavouring    to    fortify    his    action    by    such 
specious  and  flimsy  arguments  as  the  following: 
That  he  meets  these  dogmatists  for  diagnostic 
purposes  only — no  question  of  treatment  having 
arisen — for  surgical  purposes  only — in  which 
case   he   did   not   meet   the  homoeopath,    but 
treated  the   case  surgically,   the   homoepathic 
treatment    proceeding   concurrently    with    the 
surgical  attendance  ;  and  lastly  (the  sop  to  the 
general  profession)  that  his  desire  and  aim  is 
to    crush    out    homoeopathy    from    our    midst. 
Are  the  homoeopaths  whom  he  so  suavely  and 
considerately  meets  in  consultation  aware  of 
the   sinister   intentions  concealed   beneath  the  ' 
courteous  exterior  of  their  surgical  consultant  1 
Or  has  he  other   smooth  arguments  to  pacify 
the  feelings  of  resentment  that  may  be  stirred 
in  their  homoeopathic  breasts  1    Or  perhaps,  the 
homoepaths  take  a  more  practical  view  of  the 
question,  (for  their  surgeon  is  a  practical  man 
or  he  is  nothing)  and  look  upon  the   meeting 
in  the  light  of  a  business  transaction.    Having 
found  a  man  of  convenient   morality,    who  is 
willing   to    perform   services,  which  they  are 
themselves  unable   or   unwilling   to    perform, 
they  agree  to  accept  such   service   for   a   con- 
sideration. 

I  am  truly  sorry  for  the  editor  of  the  Lancet, 
for  he  is  doomed  to  disappointment ;  ambitious 
of  the  high  reputation  of  a  surgeon,  he  will 
not  find  the  experience  gathered  in  the  practice 
of  his  h  omoeopathic  friends  sufficient  to  com- 
pensate for  that  which  he  will  lose  by  such 
association,  and  he  will  realise  too  late,  that 
the  fame  upon  which  he  had  set  his  heart  has 
passed  beyond  his  grasp. 

NOTANDI   SUNT   TIBI    HORES. 


170 


CANADIAN  JOURNAL 


THE  CANADIAN 

joiiniitl  of  jlrljriii  |rif«tf^ 

A  Monthly  Journal  of  Medical  Science,  Criticism, 
and  News. 

To  Correspondents.—  IVe  shall  be  glad  to  re- 
ceive from  otir  friends  everywhere,  current  meaical 
news  oj  general  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwarding  reports  of  the  proceedings  of  their 
Associations. 


TORONTO,   MAY,  1882. 


FREEDOM  OF  CONSULTATIONS. 

The  New  York  Medical  Record,  in  its  issues 
of  8th  and  22nd  April,  contains  two  very 
specious  and  ad  captandum  editorials  on  the 
above  subject,  and  in  defence  of  the  new  code 
of  ethics  recently  promulgated  by  the  New 
York  State  Society.  The  articles  afford  from 
beginning  to  end  a  rather  startling  illustration 
(in  view  of  its  source)  of  the  form  of  argument 
known  as  petitio  principii,  and  we  should  not 
feel  called  upon  to  direct  attention  to  them  at 
all  had  it  not  been  that  in  a  recent  issue  of  the 
Canada  Lancet,  indications  of  a  somewhat  simi- 
lar tendency  were  manifest.  As  an  offset  to 
these  pernicious  publications  we  have  thrown 
together  at  random  certain  expressions  of  more 
orthodox  views  by  various  American  Journals 
and  herewith  present  them  for  the  edification 
and  encouragement  of  our  readers.  Amongst 
the  American  Journals  the  Record  stands 
almost  alone  in  its  advocacy  of  the  new  de- 
parture, and  we  regret  to  say,  judging  by  its 
last  issue,  seems  to  glory  in  its  shame.  In  our 
last  two  numbers  besides  expressing  our  own 
views  upon  the  subject  we  have  cited  the  com- 
ments of  various  portions  of  the  Press,  but  have 
not  presumed  to  suggest  a  reason  for  the 
anomalous  and  unaccountable  action  of  the 
State  Society.  The  opinion  that  the  motives 
were  purely  mercenary  has,  however,  been  pretty 
freely  expressed  as  witnesseth  the  Medical 
News  of  April  22nd  :  "  It  becomes  more  and 
more  evident  that  the  great  body  of  the  medi- 
cal profession  in  the  City  and  State  of  New 
York,  not  consulted,  and  not  recording  their 
opinions,  continue,   as  they  have  been,  opposed 


to  the  surrender  of  professional  honour,  »nd  that 
the  real  leaders  are  a  number  of  specialists 
whose  interests  are  promoted  by  the  withdrawal 
of  all  restrictions  on  consultations." 

"We  do  not  believe  in  violent  denunciation  of 
any  honestly  believing  man ;  but  we  do  main- 
tain that  there  must  of  necessity  be  a  right  and 
a  wrong  to  every  question.  If  one  man  says, 
*  You  give  too  much  medicine  in  every  case ; 
your  doses  are  too  large,  and  you  reason  from 
fallacious  grounds,'  while  his  opponent  answers, 
'  yout  doses  are  ridiculously  small  and  cannot 
have  any  appreciable  effect,'  one  or  the  other 
must  be  wrong.  It  would  be  equally  '  co7n- 
pounding  a  social  felony  '  for  the  conscientious 
homoeopath  to  consult  with  the  strictly  scientific 
physician,  as  it  would  be  to  reverse  the  case. 
Such  legislation  as  the  New  York  State  Medi- 
cal Society  has  seen  fit  to  pass  can  remove  the 
penalty  from  this  wrong-doing ;  it  can  give  the 
sanction  of  professional  law  to  this  social 
wrong  ;  but  it  cannot  remove  nor  disguise  the 
self-evident  fact,  that  when  the  conscientious 
believer  in  our  principles  and  doctrines  consents 
to  meet  at  the  bedside  one  whose  belief  and 
whose  prospective  methods  of  treatment  he 
honestly  considers  to  be  useless  or  worse  than 
useless,  he  is  doing  a  social  and  moral  wrong, 
he  is  sacrificing  his  conscience,  and  in  doing  so, 
is  fully  under  the  impression  that  he  is  doing 
his  patient  an  irreparable  injury.  This  action 
on  the  part  of  an  influential  society  has  opened 
the  ethical  door,  through  which  many  easy- 
going consciences  can  pass ;  but  let  us  hope 
that  the  better  portion  of  the  profession  will, 
as  they  always  hitherto  have,  regard  it  honestly 
impossible  to  professionally  meet  those  whose 
methods  of  curing  disease  they  consider  falla- 
cious and  invaluable.  Liberality  of  belief,  and 
tolerance  of  those  who  may  differ  from  us  in 
anything,  is  commendable,  but  conscience  must 
never  be  sacrificed." — Phila.  Med.  and  Surg. 
Journal. 

"  In  regard  to  the  question  of  consultation 
with  the  representatives  of  homoeopathy,  the 
distinguished  and  learned  author  uses  the  fol- 
lowing emphatic  language  :  *  Every  imjiulse 
of  a  legitimate  professional  pride  ;  every  senti- 
ment of  fraternal  allegiance  ;  every  feeling  of 
self-respect ;    and  every  principle  of  honor,  im- 


OF  MEDICAL  SCIENCE. 


171 


pel  us  to  refuse  professional  association  with 
such  a  system,  and  to  hold  professional  rela- 
tions with  such  men.'" — Dr.  Palmer,  University 
of  Michigan. 

"  Much  space  has  been  given  to  this  review, 
yet  when  prominent  leaders  and  officers  in  the 
American  Medical  Army  have  not  only  dishon- 
oured their  own  flag  by  trailing  it  in  the  dust, 
but,  like  the  Hessians  (despised  by  all  honor- 
able soldiers)  are  willing  to  do  service  with  an 
alien  flag,  for  pay,  it  is  time  to  draw  attention 
to  such  facts. 

"  Of  course  any  one  has  the  right  to  be  a  Hes- 
sian, but  he  must  concede  the  right  of  others 
to  point  him  out  and  to  denounce  him  as  he 
deserves.  And  the  Hessians  are  all  alike ; 
their  banner  inscription  is  '  Not  Principles, 
but  Pay.'  And  when  a  regular  physician  un- 
dertakes a  so-called  *  consultation'  with  a 
homoeopath,  wherein  there  can  not  be  either 
honourable  agreement,  or  honourable  compro- 
mise, such  an  act  is  a  fraud  upon  the  Profession, 
and  absolutely  a  fraud  upon  the  patient.  For 
any  one  to  accept  remuneration  for  co-ordinate 
service  when  such  service  has  not  been  co- 
ordinate, and  can  not  be,  is,  in  plain  English, 
a  deception ;  and  such  a  deception  is  a  fraud. 
Every  one  so  acting  should  have  pinned  upon 
him,  by  the  Press  and  by  the  Profession,  the 
inscription  on  the  Hessian's  flag  :  '  Not  Prin- 
ciples, but  Pay.'  " — American   Medical  Weekly. 

The  Chicago  Medical  Journal  and  Ex 
aminer  says,  "  The"  action  of  the  New  York 
Society  was  exceedingly  ill-timed,  because  it 
was  taken  when  it  was  apparent  to  every  well- 
informed  observer,  that  the  followers  of 
Hahnemann  were  rapidly  abandoning  their 
adherence  to  the  distinctive  features  of  homoeo- 
pathy, and  in  numerous  instances  dropping 
their  distinctive  name;  and  it  only  required 
the  maintainance  of  an  unbroken  adherence  to 
the  time-honoured  and  just  ethical  rule  that 
no  one  can  be  considered  a  fit  associate  in  con- 
sultation, whose  practice  is  based  on  an  exclu- 
sive dogma,  to  the  rejection  of  the  accumulated 
experience  of  the  profession,  to  have  substan- 
tially banished  the  name  of  homoeopath  before 
the  end  of  another  generation."  And  again, 
"  Here  is  the  fundamental  error  of  all  the  ad- 
vocates of  the  so-called  liberal  policy  of    the 


New  York  revisors.  Instead  of  recognising  the 
all-impoitant  fact  that  the  medical  science  of 
the  present  dny  is  neither  a  creed  nor  a  bundle 
of  dogmas,  but  all  that  part  of  the  domain  of 
general  science  that  relates  to  a  knowledge  of 
the  structure  and  functions  of  the  human  body 
in  health  and  disease,  and  of  those  agents  and 
influences  capable  of  modifying  such  structures 
and  functions,  they  are  constantly  using  expres- 
sions countenancing  the  public  error  that  legi- 
timate medicine  is  only  one  of  numerous 
systems,  schools  or  creeds.  They  seem  to  forget 
that  legitimate  medicine  is  inherently  and 
necessarily  liberal,  neither  knowing  nor  recog- 
nising creeds,  sects,  or  isms.  *  *  *  * 
Their  position  is  untenable  in  every  aspect 
in  which  it  can  be  viewed,  and  is  not  sustained 
by  the  action  of  any  other  respectable  body  of 
medical  men  in  Europe  or  America." 

The  Record  asserts  that  those  who  have  ex- 
pressed opinions  opposite  to  its  own  in  this  mat- 
ter are  not  the  leaders  of  professional  opinion  in 
the  parts  where  they  reside.  Without  caring 
to  deprive  it  of  the  application  of  this  flattering 
unction  to  its  soul,  we  mildly  commend  to  its 
attention  the  statements  of  another  contem- 
porary, that  "  the  profession  will  be  true  to  its 
leaders,  but  only  so  long  as  they  are  true  to 
their  colours." 

For  ourselves,  noscitur  a  sociis  is  a  time- 
honoured  and  time-vindicated  maxim,  and  we 
are  satisfied  to  regard  those  who  associate  with 
Homoeopaths,  Eclectics,  and  other  Irregulars  as 
men  of  the  same  stripe,  cast  in  the  same  mental 
and  moral  mould.  Birds  of  a  feather  flock 
together  and  aliens  are  driven  out ;  just  upon 
the  same  law  of  kindred  association  "  a  man  is 
known  by  the  company  he  keeps,"  and  those 
who  are  not  of  his  kidney  shun  his  contact, 
and  purge  themselves  of  his  offending  presence. 


Mr.  Jas.  Shuter,  M.A.,  LL.B.,  and  M.B., 
Cantab.,  F.R.C.S.,  has  been  elected  Assistant 
Surgeon  to  St.  Bartholomew's  Hospital.  The 
surgical  staff  now  stanis.  Surgeons  :  Messrs. 
Savory,  T.  Smith,  Willet,  Langton,  and  Baker; 
Assistant  Surgeons :  Messrs.  Marsh,  Butlin, 
Walsham,  Cripps,  and  Shuter — a  double  sur- 
gical quinquenvirate  probably  without  an  equal 
in  any  hospital  staff. 


im 


CANADIAN  JOURNAL 


MEDICAL  COUNCIL  EXAMINATIONS. 

As  the  appointnieut  of  a  Central  Examining 
Board  by  the  Ontario  Medical  Council  is  the 
most  important  and  useful  feature  connected 
with  that  body,  it  becomes  a  matter  of  interest 
to  consider  the  character  of  the  examination 
held  by  this  Board.  It  gives  us  much  pleasure 
to  bear  testimony  to  the  fact  that  the  recent 
Council  Examination  was  conducted  in  the 
most  thorough  and  impartial  manner.  The 
primary  (entirely  oral)  was  thoroughly  prac- 
tical, and  at  the  same  time  perfectly  fair.  The 
arrangements,  under  the  management  of  the 
indefatigable  Registrar,  were  very  complete. 
The  four  examiners  occupied  the  four  corners 
of  the  Council  Hall,  and  fr.ur  candidates  were 
examined  at  the  same  time,  fifteen  minutes 
being  allowed  for  each  subject.  As  the  candi- 
date finished  at  one  table  he  passed  on  to  the 
next.  An  improved  feature  of  this  year's  final 
examination  was  an  oral  given  to  all,  in  addi- 
tion to  the  written.  T)ie  object  was  to  make 
this  as  practical  as  possible,  especially  in  medi- 
cine and  surgery.  Of  course,  an  oral  may  be 
quite  as  unpractical  as  the  written ;  but,  in 
this  instance,  the  examination  was  as  practical 
in  medicine  and  midwifery  as  it  is  possible  to 
make  it  withou  t  taking  the  students  to  a  hos- 
pital It  wa^,  perhaps,  not  so  practical  in 
surgery.  Although  the  oral  is 'not  popular 
with  the  students,  still,  there  is  no  doubt,  it 
is  the  best  means  of  finding  out  exactly  what 
the  candidate  knows  in  a  practical  way.  The 
mere  bookworm  who  has  obtained  some  know- 
ledge of  his  subject,  but  is  unable  to  apply  it 
with  ordinary  judgment,  is  at  once  discovered. 
The  urgent  requirements  in  our  medical 
schools  at  the  present  day  are  work  in  the 
laboratories,  dissecting  rooms,  jiost-mortem 
rooms,  systematic  and  continuous  bedside 
teaching,  as  well  as  the  ordinary  clinical 
lectures,  a  complete  system  of  appointing 
surgical  dressers  and  clinical  clerks,  and  com- 
pelling them  to  perform  their  duties  properly, 
and  keep  a  correct  record  of  all  their  cases. 
The  facilities  for  all  these  are  at  our  command, 
but  the  difficulty  is  to  make  the  students  pay 
sufficient  attention  to  these  all-important  mat- 
ters. In  the  past  some,  even  though  deluged 
by  oceans  of  advice,  have  sadly  neglected  them. 


Some  have  worked  in  a  half-hearted  way,  and 
others  have  improved  all  their  opportunities  of 
gaining  practical  knowledge.  The  last-named 
are  undoubtedly  the  only  ones  fit  to  engage  at 
once  in  actiial  practice,  but  at  a  pui-ely  written 
and  unpractical  examination  they  are  fre- 
quently, if  not  generally,  beaten  by  the  book- 
worms. It  will  probably  be  generally  admitted 
that  our  examinations  were  formerly  very  de- 
fective, as  far  as  giving  any  encouragement  to 
practical  work  is  concerned,  and  it  is  at  the 
same  time  well  known  that  a  vast  improve- 
ment in  this  respect  has  taken  place  during  the 
last  few  years. 

It  is  only  just  to  the  Council  to  affirm  that 
it  has  fully  appreciated  these  facts,  and  for 
some  years  has  honestly  endeavoured  to  im- 
prove the  character  of  its  examinations;  and 
the  result  is  that  the  examination  just  com- 
pleted has,  taken  altogether,  been  the  most 
thorough  and  practical  ever  held  in  this 
country.  The  students,  who  are  very  quick  to 
discern  the  signs  of  the  times,  have  been  forced 
to  a  more  wise  coui-se  in  pursuing  their  studies, 
and,  as  a  consequence,  have  done  more  and 
better  work  in  their  laboratories,  dissecting 
rooms,  and  hospitals  during  the  past  winter 
than  ever  before,  and  we  venture  to  hope  that 
the  result  will  be  a  smaller  number  of  vacancies 
in  the  list  of  the  "  passed."  We,  of  course, 
fully  appreciate  the  value  of  reading,  but 
simply  insist  that  a  man  cannot  acquire  a 
proper  knowledge  of  our  profession,  with  all  its 
details,  from  books  alone. 


Canadian  doctors  take  great  interest  in  poli- 
tics, and  are  largely  represented  in  the  various 
Parliaments.  There  are  six  physicians  in  the 
Dominion  Senate,  and  sixteen  in  the  House  of 
Commons,  ten  in  the  Local  Parliament  of 
Ontario,  ten  in  Quebec,  three  in  Nova  Scotia, 
two  in  New  Brunswick,  and  two  in  Manitoba. 
They  are  also  largely  represented  in  Municipal 
Councils. 

Di*.  Oldright,  chairra;\n,  and  Dr.  Cassidy,  a 
member  of  the  Provincial  Board  of  Health, 
attended  the  State  Sanitary  Conv  ntion  held 
in  Greenville,  Michigan,  in  April, 

Dr.  P.  H.  Bryce,  of  Guelph,  has  been  appoint- 
ed Secretary  to  the  Ontario  Board  of  Health. 


OF  MEDICAL  SCIENCE. 


178 


KESULTS  OF  EXAMINATIONS. 

Toronto  School  of  Medicine  : — The  fourth 
year  prize  was  awarded  to  J.  T.  Duncan, 
Goderich  ;  third  year  scholarship,  W.  J,  Robin- 
son, Fergus ;  second  year,  R.  Hearn,  Ottawa; 
first  year,  Learning  Carr. 

Trinity  Medical  School  : — Final :  W.  H. 
Macdonald,  gold  medallist ;  A.  C  Gaviller, 
Ist  silver  medallist;  A.  D.  Smith,  2nd  silver 
medallist.  Certificates  of  honour  were  awarded 
to  Messrs.  Bonnar,  Cameron,  Graham,  Han- 
bridge,  J.  M.  Johnston,  J.  Johnston,  Mc- 
Causeland,  and  Sutherland.  Primary  Scholar- 
ship :  J.  E.  Jenner  and  E.  H.  Williams  (equal). 
Baptie  Prize  :  E.  H.  Williams.  Materia 
Medica  prize :  B.  H.  Scott. 

Royal  College  of  Physicians  and  Sur- 
geons, Kingston  : — Final :  passed,  R.  S. 
Anglin,  Kingston  ;  J.  Denike,  Belleville ;  A. 
Monde,  Almonte ;  H.  N.  McDonald,  Lake 
Ainslie,  C.  B.  Primary:  C.  Clancy,  L.  T. 
Davis,  G.  H.  McGhie,  D.  C.  Ilickey,  R.  Smith, 
A.  J,  Grange.  Messrs.  F.  Kidd  and  W.  J. 
Young  have  been  appointed  House  Surgeons 
for  next  year. 

McGiLL  University,  Medical  Depart- 
ment, Montreal  : — Final,  passed  :  Charles 
O'Bunn,  Ben.  W.  Burland,  Lome  Campbell, 
Angus  M.  Cattanach,  Edmund  Christie,  W.  C. 
Cousins,  Wm.  J.  Derby,  W.  T.  Duncan,  O.  H. 
A.  Dunlop,  Rankin  Dawson,  B.A.,  Hugh  Gale, 
James  A.  Grant,  B.A.,  B.  F.  W.  Hardman, 
R.  F,  Klock,  R.  K.  C.  McCorkill,  A.  R.  Mc- 
Donald, F.  N.  McLean,  W.  J.  Musgrove,  H, 
V.  Ogden,  B.A.,  T.  J.  P.  O'Brien,  Henry 
O'Keefe,  Clarendon  Rutherford,  Alex,  Shaw, 
E.  W.  Smith,  B.A.,  W.  E.  Thompson,  H.  W. 
Thornton,  B.A.  Primary,  passed  :  J.  L.  Addi- 
son, G.  Carruthers,  L.  G.  Cook,  T.  B.  Davies, 
J.  A.  Duncan,  E.  .'.  Elderkin,  Hugh  Gale,  C. 
E.  Gooding,  G.  A.  Graham,  W.  G.  Henry,  J. 
R.  Johnson,  W.  G.  Johnston,  Ovide  Martel. 
J.  C.  Meahan,  .'.  .».  Maher,  John  Menzies,  N. 
J.  McDonald,  J.  P.  Mclvernay,  Isaac  W.  Mc 
Lean,  B.A.,  J.  W.  McLean,  Arch.  MeLeod, 
B.A.,  A.  McNeill,  W.  M.  Nelson,  S.  S. 
C.  Phippen,  Wra.  Porteous,  W.  S.  Renner, 
W.  K.  Ross,  George  B.  Rowell,  E.  H. 
Smith,  Herbert  E.  Smyth,  Felix.  D.  Walker, 
S.  F.  Wilson,  .BA.,  E.  S.  Wood.    The  Holmes 


medal  was  awarded  to  R.  J.  B.  Howard,  B.A., 
Montreal.  Prize  for  final :  H.  V.  Ogden,  B.A., 
St.  Catharines.  Primary  prize:  Geo.  A.  Graham, 
Hamilton ;  Sutherland  Gold  medal :  W.  G. 
Johnston.  Mortice  scholarship  in  Physiology  : 
W.  G.  lohnston.  Botany  prize:  Edwin  G. 
Wood.  Practical  Anatomy  prize :  George 
Carruthers. 

Bishop's  College,  Medical  Department. — 
Final,  passed:  Heber  Bishop,  B.A. ,  N.  C. 
Smilie,  J.  W.  Cameron,  W.  D.  M.  Bell,  G.  A. 
Balcom,  Walter  Prendergast.  Primary,  papsed: 
J.  B.  Saunders,  J.  A.  Caswell,  G.  A.  Balcom,  E. 
Sirois,  W.  D.  M.  Bell,  W.  Prendergast. 

University  of  Victoria  College  : — Final, 
passed  :  W.  H.  Aikins,  B.  A.,  Toronto  ;  R.  J.  F. 
Burton,  Warkworth;  J.  Campbell,  Wingham ;  .1 . 
T.  Carroll,  Marsville;  G.  W.  Clendenan,  Jordan; 
M.  K.  Collver,  Wellandport ;  R.  M .  Coulter,  Rich- 
mond Hill;  M.  R.  Elliott,  Goderich;  H.  P. 
Jackson,  Simcoe ;  W.  J.  Kellow,  Tara;  Elgin 
Laws,  St  Catharines;  W.  G.  S.  McDonald; 
W,  H.  Montague,  Dannville  ;  S.  R.  Rogers, 
Cedarville ;  David  Rose,  Port  Ryerse ;  W.  A. 
Ross,  Barrie;  J.  B.  Whitely,  Goderich  ;  J.  W. 
Willmot,   Richmond   Hill.     Primary,   passed : 

D.  Campbell,    Port    Perry;   F.    E.    Case;  C. 

E.  Cochrane,  Colborne  ;  C.  M.  Foster,  Jamaica; 
E.  M.  Hewish,  Heathcote  ;  W.  Jaques,  .^arvis; 
Wm.  Kennedy,  Toronto ;  L.  G.  Langstaflf, 
LangstajQT;  S.  E.  C.  McDowell,  Bowmanville  ; 
Alex.  Sangster,  Port  Perry;  Miss  A.  Stowe, 
Toronto. 

College  of  Physicians  and  Surgeons 
OF  Ontario.  —The  following  gentlemen  passed 
the  Primary  Examination  of  the  College  of 
Physicians  and  Surgeons  of  Ontario:  J.  L. 
Addison,  W.  G.  Anglin,  James  Bray,  J. 
W.  Gierke,  John  Cryan,  Wm.  Cuthbertson, 
W.  H.  Carleton,  Duncan  Campbell,  A  P. 
Cornell,  H.  R.  Ca«grain,  W.  F.  Dickson, 
J.  G.  Davidson,  F.  P.  Drake,  W.  F.  Freeman, 
R.  W.  Eraser,  G.  A.  Graham.  J.  B.  Gullen,  J. 
E.  Hansler,  R.  Hearn,  A.  J.  Henwood,  Wm. 
Jacques,  J.  M.  Johnston,  J.  F.  Kidd,  F.  D. 
Kent,  L.  G.  Langstaff,  T.  D.  Meikle,  John 
Menzies,  A.  F.  McKenzie,  S.  W.  McConachie, 
Archibald  McMurchy,  E.  B.  O'Reilly,  L.  C. 
Prevost,  T.  H.  Robinson,  J.  W.  Ray,  W.  A. 
Ross,  James  Spence,  Alex.  Sangster,  W.  F. 
Shaw,  Miss  Augusta  Stowe,  F.  H.  Sawers,  A. 


174 


CANADIAN  JOURNAL 


D.  Thompson,  A.  D.  Watson,  J.  B.   Whitely, 

E.  R.  Woods,  J.  D.  Wilson,  P.  C.  Walmsley. 
Final :  Frank  Bentley,  Lafayette  Bentley,  T, 
G.  Brereton,  James  Baugli,  .1.  C.  Burt,  Wm. 
Bonnar,  G.  S.  Beck,  J.  F.  Bell,  E.  E.  Book, 
Wm.  Bret^,  E  Bedard,  G.  W.  Clendenan,  A. 
Cameron,  G.  S.  Cleland,  A.  P.  Cornell,  R.  M. 
Coulter,  W.  J.  Charlton,  L.  E.  Day,  G.  C. 
Dowsery,  J.  T.  Duncan,  C.  R.  Dickson,  J,  G. 
Davidson,  W.  F.  Eastwood,  Ira  A.  Freel,  R. 
M.  Fisher,  A.  C.  Caviller,  R.  W.  Garrett, 
Wm.  Gilpin,  Wm.  Hanbridge,  A.  0.  Henwood> 
D.  A.  Johnston,  J.  M.  Johnston,  W.  H.  John- 
son, C.  E,  Jarvis,  James  Lafferty,  J.  G.  Men- 
nie,  T.  M.  Milroy,  M.  McPhoden,  H.  P.  Mc- 
Causland,  H.  R.  McGill,  T.    F.   McMahon,    7. 

F.  O'Keefe,  L.  C.  Prevcst,  S.  R.  Rogers,  D.  B. 
Rutherford,  David  Rose,  B.  L.  Riordan,  H. 
H.  Reeve,  T.  J.  Symington,  J.  K.  Shore,  A.  D 
Smith,  Alex.  Stark,  f.  M.  Stewart,  W.  F. 
Shaw,  T.  H.  Stark,  E.  D.  Vanderwort,  R.  R. 
Wallace,  A.  B.  Welford,  C.  A.  Weagant. 


SUIT  FOR  MALPRACTICE. 

This  was  an  action  brought  against  Dr.  Wm. 
Brock,  of  Bismarck,  by  a  Mr.  Malcolm,  and 
was  tried  at  St.  Thomas,  April  7th.  The  par- 
ticulars are  as  follows  :  The  plaintiff  received 
an  injury  to  the  shoulder,  and  vent  at  once  to 
Dr.  Brock  for  treatment.  The  Dr.  pronounced 
it  a  severe  bruise ;  said  there  was  no  displace- 
ment, and  bad  the  patient  under  observation 
about  five  weeks.  At  the  expiration  of  this 
period,  the  man  being  very  anxious  about  his 
shoulder,  on  account  of  the  severe  pain  he  ex- 
perienced, consulted  two  other  physicians 
separately,  both  of  whom  told  him  there  was  a 
dislocation.  A  short  time  after  this  (about 
eight  weeks  after  the  receipt  of  tho  injury)  he 
went  to  the  hospital  in  London,  when  the  sur- 
geons recognised  a  ditslocation,  and  made  an 
attempt  to  reduce  it,  but  without  success. 

At  the  trial  three  surgeons  subpoenaed  by  the 
plaintiff,  Dr.Tye,  of  Chatham  (formerly  Thames- 
ville),  and  the  two  local  doctors  who  first 
saw  patient  after  defendant  had  treated  him, 
agreed  in  saying  there  was  a  subcoracoid  dis- 
location of  the  humerus,  so  well  marked  as  to 
leave  no  shadow  of  doubt  in  their  minds.     The 


defendant  stated  there  was  no  dislocation,  and 
had  been  none  since  the  injury.  It  came  out 
in  evidence,  however,  that  ho  had  on  two 
different  occasions  tried  extension  with  the 
heel  in  the  axilla,  with  the  intention,  he  said, 
of  stretching  the  nerves  and  thereby  lessening  the 
pain.  The  other  doctors  called  on  behalf  of 
the  defence  were  not  put  in  the  witness  box. 
The  jury  returned  a  verdict  for  the  plaintiff? 
with  damages,  $900. 

There  was  no  attempt  to  show  any  negligence 
on  the  part  of  the  defendant,  but  sini{)ly  want 
of  skill.  There  can  be  no  doubt  that  he  com- 
mitted a  grave  error  in  judgment,  and,  while 
he  was  doing  his  best  for  his  patient,  the  price 
demanded  for  his  error  appears  to  us  very 
high.  While  we  sympathize  with  Dr.  Brock, 
who,  during  his  i)ractice  of  eight  years,  has 
always  been  careful  and  painstaking,  we  hope 
■that  he  and  others  will  learn  from  the  result 
of  this  unfortunate  case  the  great  importance 
of  insisting  on  consultations  in  all  cases  of 
injury  at  or  near  the  joints  where  the  symp- 
toms are  at  all  severe  or  obscure.  Unfortun- 
ately, some  medical  men,  with,  a  perversity 
which  is  entirely  inexplicable,  as  well  as  inex- 
cusable, persistently  object  to  consultations. 
Such  conduct  is  both  unjust  and  impolitic  : 
unjust,  because  it  deprives  the  patient  of  the 
advantnges  whicb  may  accrue  :  impolitic,  be- 
cause it  throws  on  the  surgeon's  shoulders  the 
full  responsibility  of  any  mishaj)S  which  may 
arise 


DOES  IT  PAY? 


Our  readers  are  probably  tii*ed  of  seeing  our 
reiterated  protests  on  the  subject  of  "  news- 
paper offences  against  the  profession,"  and 
would,  perhaps,  be  glad  to  give  up  the  crusade 
in  disgust,  for  many  think,  "Xejew  ne  vautpas 
la  chandelle."  However,  we  do  not  despair, 
for  doubtless,  like  other  hydraheaded  mon- 
sters, this  too,  can  be  exterminated  by  courage 
and  perseverance.  Where  the  perception  of 
ethical  niceties  is  blunt,  and  the  regard  for 
other  people's  feelings  callous,  it  is  generally 
found  that  the  nerve  supplying  the  pocket  is 
peculiarly  sensitive,  and  accordingly  we  appeal 
to  recalcitrant  newspaper  men  through  this 
channel  of  communication,  and  enquire,  "  Does 


OF  MEDICAL  SCIENCE. 


176 


it  x-eally  pay  ? "  The  Chatham  papers  recently 
afford  some  instances  of- bad  taste,  and  short- 
sighted policy  in  this  respect ;  and  the  Editor 
of  the  Planet  says,  in  commenting  upon  a 
letter  to  his  paper  on  "  Too  much  puff."  "  If 
the  item  comes  from  sources  outside  the  passive 
and  active  partners  of  the  amputation,  then 
the  reporter  is  free  to  use  his  own  judgment  as 
to  the  propriety  of  publication,  and  the  local 
news-hunter  of  1882,  is  the  last  man  in  the 
world  to  sacrifice  his  item,  gained  after  a  long 
chase,  on  the  altar  of  medical  etiquette,  even 
under  the  august  image  of  CEsculapius."  We 
subjoin  two  disgusting  samples  of  Chatham 
news-hunters'  judgment : — 

"  Do  Eead  This. — Two  cases  of  small-pox, 
between  Com.ber  and  Stoney  Point,  and  early 
in  the  week,  the  man  who  brought  the  news, 
very  wisely  received  vaccination  at  the  hands 
of  Dr.  Holmes.     Go  thou  and  do  likewise." 

"  A  Modern  Miracle. — Dr.  Sievewright 
performed  a  very  remarkable  operation  on  Mr. 
Antoine,  of  Munceytown,  who  had  been  stone 
blind  for  nine  months.  Under  the  doctor's 
skilful  operating  hands,  the  unfortunate  has 
regained  heaven's  greatest  physical  blessing — 
sight." 

And  we  ask  the  editor  to  tell  us  candidly  if 
he  can  afford  to  sacrifice  the  good  opinion  and 
the  good-will  of  the  profession  for  any  profit 
to  be  derived  from  such  "  perilous  stuff."  The 
general  reader  cannot  positively  care  for,  or 
take  an  active  interest  in  such  intellectual 
pabulum  as  this ;  and  it  can  only  prove  dis- 
tasteful and  irritating  to  the  professional  por- 
tion of  the  community.  The  answer  to  the 
question  must,  therefore,  be,  "  It  does  not  pay;" 
and  accordingly,  on  pure  business  principles, 
if  for  no  higher  reasons,  the  practice  should  be 
abandoned.  If  some  newspaper  men  are  so 
obtuse  as  to  fail  altogether  to  see  the  matter  in 
this  light,  then  we  hold  it  to  be  the  duty  of 
medical  practitioners,  not  only  to  themselves 
but  to  the  profession  also,  to  put  the  proposition 
in  concrete  terms  and  discountenance  those 
journals,  both  personally  and  through  their 
friends,  which  persist  in  defying  and  doing 
violence  to  a  well  recognized  and  honourable 
esprit  de  corps. 


MANUFACTURING  DOCTORS. 

They  are  manufacturing  more  doctors  in  the 
United  States,  in  proportion  to  the  population, 
than  any  country  in  the  world.  Perhaps,  one 
of  the  chief  reasons  is  the  fact  that  it  is  there 
such  an  easy  matter  to  acquire  the  license  to 
practice.  In  many  quarters,  they  require  little 
or  no  preliminary  training,  a  very  short  time 
of  attendance  on  lectures,  and  then  put  the 
candidate  through  the  farce  of  what  is  called 
an  examination,  after  which  they  send  him 
forth  to  the  world  as  a  fully-fledged  Doctor  of 
Medicine — a  member  of  the  regular  profession, 
which  we  are  pleased  to  hold  in  high  esteem. 

We  have  a  good  example  of  these  rapidly 
grinding  mills  in  the  city  of  Detroit,  where  a 
young  man  can  matriculate,  attend  one  course 
of  lectures,  pass,  and  go  out  a  fully-licensed 
practitioner,  although  possessing  only  that 
diminutive  amount  of  knowledge  which  is 
really  more  danger  us  than  simple  ignorance 
It  is  true  that  this  institution,  which  has  the 
assurance  to  class  itself  aT.ong  the  respectable 
teaching  bodies  of  the  country,  pretends  to 
require  attendance  on  two  courses  of  lectures, 
and  yet  we  know  that  it  has  given  its  diploma 
to  men  who  have  not  shown  tickets  for 
attendance  on  more  than  one  course  of  lectures 
in  any  branch  of  medicine.  It  must  be  some 
what  discouraging  to  the  respectable  Medical 
Institutions  of  New  York,  Boston,  Philadelphia, 
and  other  cities,  to  be  placed  on  a  level,  as  far 
as  the  power  of  granting  degrees  is  concerned, 
with  any  such  school  as  the  one  referred  to. 
Under  the  circumstances  we  can  hardly  wonder 
at  the  comparative  success  of  outsiders  practising 
in  the  State  of  Michigan,  as  it  must  be  easy  to 
win  in  the  race  with  men  who  must  of  neces- 
sity be  sadly  deficient  in  ordinary  mental 
culture  and  scientific  medical  training. 

In  Ontario,  nothing  so  disgraceful  can  occur, 
thanks  to  those  who  established  the  Medical 
Council  as  it  is  at  present  constituted.  It 
gives  us  what  many  in  the  United  States  wpuld 
like,  a  Central  Examining  Board;  and  we 
should  never  lose  sight  of  this  important  fact, 
while  called  upon  too  frequently  to  criticize 
many  imperfections  and  stupid  mistakes  in 
the  past  history  of  the  Council's  proceedings. 


176 


CANADIAN  JOURNAL 


DEATH  FROM   A  DRUGGIST'S 
MISTAKE. 

Richard  Wanless,  aged  16,  a  druggist's  clerk, 
was  tried  at  Walkerton,  April  12th,  for  man- 
slaughter. It  was  supposed  that,  in  making 
up  a  prescription  for  Mrs.  Moore  (written  by 
Dr.  Smith),  he  made  the  mistake  of  substitut- 
ing prussic  acid  for  hydrobromic  acid,  and  the 
prussic  acid  had  caused  the  death  of  the  wo- 
man. Although  the  case  appeared  very  clear, 
the  prisoner  was  released  on  a  technical  point 
arising  out  of  the  fact,  that  no  post-mortem  ex- 
amination had  been  made,  and  consequently 
there  was  no  evidence  to  prove  positively  the 
cause  of  death.  His  Lordship  the  Judge, 
while  withdrawing  the  case  from  the  jury,  re- 
marked that  he  felt  there  was  rather  a  lament- 
able failure  of  justice. 

The  case  is  a  very  sad  one  in  every  respect, 
and  teaches  us  the  alarming  fact,  that  the  lives 
of  our  citizens  in  some  places  are  continuously 
imperilled  by  the  loose  and  careless  way  in 
which  drug  stores  are  managed.  The  evid- 
ence at  this  trial  showed  almost  (if  not  quite) 
criminal  neglect  on  the  part  of  the  proprietoi' 
of  the  drug  store.  In  the  first  place,  there 
was  not  proper  care  taken  in  separating  and 
distinguishing  the  poisonous  from  the  com- 
paratively harmless  drugs,  either  by  conspicuous 
labels,  or  peculiar  colour  or  shape  of  bottles;  in 
the  second  place,  an  opportunity  was  afforded 
a  lad,  ignorant  of  the  properties  of  the  med- 
icines he  was  handling,  to  deal  out  deadly 
poisons  to  any  one  who  might  call  lor  them, 
notwithstanding  the  fact  that  he  was  several 
times  forbidden  to  make  up  prescriptions  dur- 
ing his  employer's  absence. 


The  Splenic  Pulse. — From  Dr.  Roy's  late 
observations  "it  appears  [Brit.  Med.  Jl.)  that 
normally  (in  cats  and  dogs  at  least)  the  spleen 
alternately  contracts  and  expands  with  great 
regularity,  presenting  systolic  and  diastolic 
phases  about  once  a  minute,  and  that  it  thus 
carries  on  its  own  circulation,  independently 
of  the  general  blood  pressure."  Dr.  Roy's 
paper  is  to  be  found  in  the  Journal  of  Physi- 
ology^  vol.  iii  No.  3. 


Senate  Election,  University  of  Toronto. 
— The  voting  papers  will  be  opened,  May  3rd. 
The  candidates  are  William  Oldright,  M.A., 
M.D.,  John  Boyd,  M.A.,  B.C.L.,  John  Gal- 
braith,  M.A.,  C.E,  and  William  Houston, 
M.  A.,  three  of  whom  are  to  be  elected. 


EcHiNOCoccus  Disease. — We  desire  to  ask 
our  readers  who  have  met  with  or  who  know 
of  instances  of  hydatid  diseasa  occurring  in 
Ontario,  if  they  will  kindly  forward  to  us 
without  delay  references  to,  or  particulars  of 
such  cases. 


The  Medical  Association  of  Ontario. — 
The  second  meeting  of  the  Ontario  Medical 
Association  will  be  held  in  Toronto,  on  Wed- 
nesday, June  6th. 


PERSONAL. 


Dr.  Tye,  of  Thamesville,  has  moved  to 
Chatham. 

Dr.  J.  H.  Duncan,  of  Seaforth,  takes  Dr. 
Tye's  place  in  Thamesville. 

Dr.  John  Campbell,  of  Seafoith,  Ont.,  has 
been  admitted  L.R.C.P,  Edinburgh. 

Dr.  Sbeard,  of  Toronto,  sailed  for  England 
in  April,  and  expects  to  be  away  some  months. 

A  new  museum  is  to  be  built  for  the  Uni- 
versity of  Michigan  at  a  cost  of  $60,000. 

Dr.  D.  J.  Cunningham  has  left  Edinburgh 
to  become  Professor  of  Anatomy  to  the  Royal 
College  of  Surgeons  in  Ireland. 

Sir  Edward  Burrowes  Sinclair,  King's 
Professor  of  Midwifery  in  Trinity  College, 
Dublin,  died  on  24th  March,  aged  57. 

The  death  of  Sir  Wyville  Thompson,  LL.D., 
Professor  of  Natural  History  in  the  University 
of  Edinburgh,  is  announced. 

Dr.  J.  E.  Graham,  of  Toronto,  sails  for 
Europe,  May  4th.  He  expects  to  s^jend  a  few 
months  in  London  and  Leipsic  or  Vienna. 

The  late  Dr.  Pancoast,  of  Philadelphia,  was 
worth  a  million  dollars.  His  favourite  amuse- 
ment was  playing  checkers. 

There  were  two  female  students  at  the  Phila- 
delphia College  of  Pharmacy  during  the  past 
session. 

Mr.  E.  Ray  Lankester,  M.A.,  F.R.S.,  of 
University  College,  London,  has   been   elected 


O^  MEDICAL  SCIENCP. 


177 


to  fill   the    vacancy   created   by   Sir   Wyville 
Thompson's  resignation  and  death. 

Dr.  G.  W.  Balfour,  in  March  last,  severed 
his  connection  with  the  Royal  Infirmary  of 
Edinburgh.  Dr.  Wyllie,  the  Senior  Assistant 
Physician,  succeeds  him. 

The  late  Mr.  John  Jones  of  Piccadilly, 
London,  has  left  by  his  will,  a  quarter  million 
dollars  to  the  Royal  National  Hospital  for 
Consumption,  Ventnor,  Isle  of  Wight. 

Of  the  fifty-six  professors  of  Harvard  College, 
forty-three  are  graduates  of  Harvard — a  notable 
instance  of  an  Alma  Mater  appreciating  her 
own  children. 

Hermann  Von  Schlagintweit,  the  celebrated 
naturalist  and  traveller,  who  died  on  the  19th 
January,  bequeathed  his  skull  and  brain  to  the 
Anatomical  Institute,  at  Munich. 

We  inadvertently  omitted  to  state  in  our 
February  number  that  Drs.  W.  C.  Edmondson 
and  W.  H.  Aikins,  from  the  Toronto  School 
of  Medicine,  had  each  received  the  L.R.C.P., 
Lond. 

At  the  recent  examinations  (trial),  a  candi- 
date was  asked  the  meaning  of  "Entropion," 
and  caused  an  audible  smile  in  the  examiner  by 
his  answer : — "  Excessive  and  insane  desire  for 
sexual  intercourse." 

Mr.  Henry  Montgomery,  M.  A.,  B.Sc, 
Lecturer  on  Botany  and  Zoology,  Toronto 
School  of  Medicine,  is  at  present  engaged  at 
practical  work  in  Johns  Hopkins'  University, 
Baltimore. 

Dr,  John  S.  Billings,  in  speaking  of  the  late 
International  Medical  Congress  held  at  London, 
says ;  "  Although  the  great  Congress  is  gone,  it 
is  not  like  a  flame  blown  out,  but  like  a  handful 
of  seeds  scattered." 

Dr.  Covemton,  of  Toronto,  and  Dr.  Yeomans, 
of  Mount  Forest,  members  of  the  Provincial 
Board  of  Health,  have  been  engaged  during 
the  latter  part  of  April  in  investigating  the 
causes  of  the  typhoid  epidemic  in  Sarnia.  We 
have  not  yet  heard  their  report. 

Commendatore  Corrado  Tommasi  Crudeli, 
has  been  appointed  Professor  of  Experimental 
Hygiene  and  Director  of  the  Corresponding 
Department  in  the  University  of  Rome.  Dr. 
Marchiafava  has  been  appointed  to  the  Chair 
of  Pathological  Anatomy  thus  vacated. 


Dr.  Samuel  D.  Gross,  for  twenty-six  years 
Professor  of  Surgery  at  the  Jeflferson  Medical 
College,  has  resigned :  cause,  infirmities  of 
advancing  age,  which  is  seventy-seven.  He  has 
been  elected  Emeritus  Professor  of  Surgery  in 
the  same  college,  and  the  work  he  has  done 
will  be  divided  between  his  son,  Dr.  Samuel 
W.  Gross,  and  Dr.  John  H.  Brinton. 

Dr.  E.  C.  Spitzka,  of  New  York,  was  elected 
President  of  the  New  York  Neurological 
Society  on  4th  April.  This  selection  is  generally 
regarded  as  a  professional  denunciation  of  the 
unjust  and  ungenerous  treatment  snfiered  by 
this  distinguished  scientist  in  the  Guiteau  trial. 


(f)bitMrwi8i. 


FREDERICK   H.    WRIGHT,    M.B., 
L,R.C.P.,  Lond. 

Dr.  Fred.  Wright  was  one  of  the  best  known 
among  our  young  physicians  in  Ontario,  and  his 
sad  death,  at  so  early  an  age,  wiU  be  a  matter 
of  the  deepest  regret  to  a  large  portion  of  our 
readers  who  were  personally  acquainted  with 
him.  He  was  the  eldest  son  of  Dr.  H.  H. 
Wright,  born  at  Markham,  in  1849,  being  33 
years  of  age  at  the  time  of  his  death.  He  re- 
ceived his  preliminary  education  in  the  old 
Toronto  Grammar  School,  and  Upper  Canada 
College  ;  commenced  the  study  of  medicine  in 
the  fall  of  1868,  in  the  Toronto  School  of 
Medicine,  and  graduated  in  Toronto  University 
in  1872,  passing  the  Ontario  Medical  Council 
the  same  year.  During  his  undergraduate 
course  he  spent  much  of  his  time  in  his  father's 
office,  and  was  also  engaged  for  a  time  in  Prof. 
Croft's  Chemical  Laboratory.  After  spending 
the  summer  of  1871  in  New  York,  visit- 
ing the  various  Hospi.als  and  Dispensaries  of 
that  city  he  went  to  England  in  the  summer 
of  1872,  and  remained  in  London  for  more  than 
two  years  attending  the  different  Hospitals,  but 
principally  St.  Thomas's  where  he  was  a  great 
favourite  with  many  of  the  teachers,  especially 
Dr.  Peacock.  While  attending  St.  Thomas's 
he  passed  his  examination  before  the  College  of 
Physicians,  London.  A  vacancy  in  the  resident 
staff* having  occurred  in  the  Hospital  for  Diseases 
of  the  Chest,  Victoria  Park,  East  London,  he 
was  appointed  to  the  position,  chiefly  through 


178 


CANADIAN  JOURNAL 


the  influence  of  Dr.  Peacock,  who  had  formed 
a  high  opinion  of  his  attainments  ;  and,  during 
his  residence  of  six  months,  his  conduct  gave 
the  highest  satisfaction  to  the  attending  physi- 
cians. While  in  London  he  was  always  en- 
gaged in  practical  work,  and,  among  other 
things,  took  a  very  thorough  course  in  micros- 
copy. On  his  return  to  Canada  in  the  fall  of 
1874,  he  at  once  engaged  in  practice  iu  Toronto, 
in  which  he  was  unusually  successful,  until 
failing  health  gradually  compelled  him  to  give 
it  up.  He  was  connected  with  various  city 
charities  and  was  for  some  time  Physician  to  the 
Toronto  Dispensary,  and  also  acted  as  assistant 
to  his  father  in  the  Toronto  General  Hospital. 
As  Demonstrator  of  Microscopical  Anatomy 
in  the  Toronto  School  of  Medicine,  and  act- 
ing Secretary  of  the  Faculty  he  was  a  ^reat 
favourite  with  the  students.  Both  as  stu- 
dent and  practitioner  he  was  always  pre- 
eminently practical.  He  possessed  good  abili- 
ties, and  unusually  good  judgment  in  all 
things  ;  was  skillful  in  diagnosis,  careful  and 
judicious  in  treatment.  In  diseases  of  the  chest 
and  abdomen  he  was  undoubtedly  one  of  the 
most  skilled  diagnosticians  we  had  in  Canada. 
His  manner  was  such  as  to  inspire  confidence 
in  his  patients.  In  fact,  he  combined  within 
himself  the  various  elements  which  go  to  form 
a  successful  physician,  and  at  one  time  there 
was  every  prospect  of  a  bright  future  before 
him.  Bxit  it  was  not  to  be,  and  two  or  three 
years  ago  his  health  began  to  fail.  The  change 
was  so  gradual  that  his  friends  did  not  notice 
or  appreciate  it,  for  some  time.  Before  long, 
however,  undoubted  signs  of  phthisis  appeared. 
Last  summer  and  fall  he  failed  rather  rapidly. 
Shortly  after  the  advent  of  the  new  year  he 
was  confined  entirely  to  the  house  and  passed 
peacefully  away  on  the  19th  of  April. 

To  those  who  knew  him  in  his  student's  days 
it  is  hard  to  realize  that  he  who,  a  few  short 
short  years  ago,  was  so  bright,  so  cheerful,  so 
full  of  health,  strength,  and  happiness,  so  suc- 
cessful in  all  his  undertakings,  has  gone  to  his 
long  Iu>me.  We  wish  the  heartfelt  sympathy 
of  innumerable  friends  in  this  city  and  pro- 
vince, could  in  the  slightest  degree  assuage  the 
inexpressible  grief  of  the  mother,  father,  sisters, 
and  brother,  in  their  sad  affliction.    The  funeral 


took  place  on  the  2 1st  of  April,  and  was  largely 
attended,  especially  by  the  profession  in  and 
outside  of  Toronto,  including  leading  represen- 
tatives from  both  Schools  of  Medicine.  The 
Managers  of  this  Journal  are  especially  in- 
debted to  him  for  active  co-operation  in  its 
foundation. 


Prof.  Erskine  Mason,  A.M.,  M.D.,  New 
York,  died  suddenly  on  the  13th  of  April  last, 
at  the  age  of  forty-five.  He  had  held  the 
following  professional  appointments :  Demon- 
strator of  Anatomy  in  the  College  of  Physi- 
cians and  Surgeons,  Adjunct  Professor  of 
Surgery  in  the  Medical  Department  of  the 
University  of  the  City  of  New  York,  and 
Assistant  Surgeon  to  the  New  York  Eye  and 
Ear  Infirmary.  He  was  also  Surgeon  to 
Bellevue  Hospital,  Roosevelt  Hospital,  and  to 
the  Coloured  Home  The  Medical  Record  says, 
"  Dr.  Mason  had  acquired  a  very  high  reputa- 
tion as  a  bold  and  skilful  operator,  and  he  was 
justly  ranked  among  the  first  surgeons  of  the 
city." 

1  ■  ♦  w  ■ 

Dr.  Geo.  Budd,  F.R.S.,  for  many  years 
Professor  of  Medicine  and  Physician  in  King's 
College  Hospital,  died  on  the  14th  March. 
He  is  best  known  by  his  work  on  Diseases  of 
the  Liver,  and  that  on  Organic  Diseases  and 
Functional  Disorders  of  the  Stomach.  He 
was  third  wrangler  in  mathematics  in  1831, 
graduated  M.D.  Cantab  in  1840,  and  became 
a  Fellow  of  the  Royal  College  of  Physicians  in 
1842.     He  had  attained  the  age  of  76  years. 

Annual  Report  o/tlte  Asylum  for  tlie  Insane, 
Kingston,  Ont.,  for  the  year  endiny  30th 
September,  1881. 


Report  of  the  Medical  Superintendent  of  the 
Asylum  for  the  Insane,  Toronto,  for  the  year 
ending  30th  September,  1881. 

Civilization  in  its  Relation  to  the  Decay  of 
the  Teeth.  By  Norman  W.  Kings  ley,  M.D.S., 
D.D.S.     New  York  :  D.  Appleton  &  Co. 


OF  MEDICAL  SCIENCE. 


i79 


Proceedings  of  Meetings  held,  February  lat, 
1882,  at  New  York  and  London  to  express 
sympathy  with  tlie  oppressed  Jews  in  Rvssia. 


On  Some  Points  in  Connection  with  the 
Treatment  of  Sterility.  By  A.  Reeves  Jackson, 
A.M.,  M.D.,  Chicago,  illustrated.  (Reprint 
from  Gyncecological  Transactions.  1879.) 


Inebriety :  A  Study  upon  Alcohol  in  its  Re- 
lations to  Min/1,  and  Conduct.  By  T.  L. 
Wright,  M.D.,  Belief ontaine,  Ohio.  (Reprint 
from  Alienist  and  Neurologist.) 


Annual  Report  of  the  Board  of  Health  of 
the  State  of  Louisiana  to  the  General  Assembly 
for  the  year  1882.  New  Orleans :  Joseph  Jones, 
M.D.,  President;  S.  S.  Herrick,  M.D.,  Secre- 
tary ;  J.  S.  Rivers,  74  Camp  street.  Printer. 


A  ^Treatise  on  Human  Physiology.  By  John 
C.  D ALTON,  M.D.,  Professor  of  Physiology, 
College  of  Physicians  and  Surgeons,  New 
Y"ork.  etc.  Seventh  edition.  Philadelphia: 
Henry  C.  Lea's,  Son  <fe  Co. 

Dalton's  Physiology  is  too  well  known  to 
require  a  critical  review.  The  principal  changes 
found  in  this  edition  appear  in  sections  on  prox- 
imate principles,  nervous  system,  and  reproduc- 
tion. The  term  proximate  principles,  however, 
is  dropped,  the  subject  being  treated  under  the 
title  of  Physiological  Chemistry,  and  more 
extensively  than  formerly.  The  greatest  im- 
provements in  the  book  will  probably  be  found 
in  section  on  the  Nervous  System,  where 
special  attention  has  been  paid  to  the  subject 
of  localization,  the  relationship  existing  be- 
tween the  different  portions  of  the  cerebro- 
spinal system,  vaso-motor  nerves,  <kc.  The  sec- 
tion on  reproduction  is  considerably  changed, 
somewhat  abbreviated,  but  still  retains  its 
place  as  the  best  exposition  we  have  on  the 
subject.  Altogether  the  book  is  about  the 
same  size  as  last  edition.  The  work  is  printed 
and  bound  in  "Lea's"  best  style,  which  is 
certainly  not  surpassed,  if  equalled,  by  any 
medical  publishing  house  in  the  world. 


The  Illustrated  Quarterly  of  Medicine  and 
Surgery.  Edited  by  Geo.  Henry  Fox,  M.D., 
Clin.  Prof.  Dis  of  Skin,  Coll.  of  Physcians 
and  Surgeons,  New  York,  and  Frederick  R. 
Sturois,  M.D.,  Prof.  Venereal  Dis.,  Med. 
Dept.  University,  City  of  New  York. 
New  York  :  E.  B.  Treat,  757  Broadway. 

This  is  a  new  venture  in  Medical  Journalism 
which  pre-eminently  deserves  general  support, 
presenting  as  it  does,  not  o  ly  excellent  clinical 
accounts  of  interesting  cases  in  practice  but  also 
highly  artistic  pictorial  representations  (both 
photographs  and  drawings)  of  the  subjects  of 
the  cases  themselves.  We  cannot  more  highly 
recommend  the  work  to  our  professional 
brethren  than  by  quoting  the  names  of  the 
editorial  collaborateurs,  and  of  the  contributors 
to  the  first  two  numbers  which  are  before  us  : 
Prof.  Willard  Parker,  A.  C.  Post,  W.  H.  Van 
Buren,Jas.  R.  Wood,  i.  L.  Little, T.  G.  Thomas, 
A.  L.  Loomia,  F.  Delafield,  D.  B.  St.  J.  Roosa, 
C.  R.  Agnew,  and  Austin  Flint,  are  associate 
editors.  The  contents  of  the  first  number  are 
Restoration  of  Upper  Lip  (five  illustrations) 
by  A.  C.  Pest ;  Fibrous  Tumour  of  Face  (three 
illustrations)  by  Willard  Parker  ;  Laparotomy 
for  Removal  of  Menstrual  Blood,  etc.,  (five 
illustrations)  by  T.  G.  Thomas.  Separation 
of  Lower  Epiphysis  of  Femur  (two  illustra" 
tions)  by  J.  L.  Little ;  Dislocation  of  Colum- 
nar Cartilage  of  Nose  (one  illustration)  by 
F.  H.  Bos  worth ;  Facial  Paralysis  in  con- 
nection with  Aural  Disease,  (four  illustra- 
tions) by  S.  Sexton ;  and  a  Rare  Form  of  Cor- 
neal Opacity  (one  illustration)  by  T.  R.  Pooley. 
Number  2  contains  :  Ovarian  Pregnancy,  (one 
illustration)  by  Isaac  E.  Taylor ;  Facial  Atro- 
phy (one  illustration)  by  E.  C.  S^uin  ;  Plastic 
Operations  for  Loss  of  Nose,  Lower  Eyelids, 
etc.,  (nine  illustrations)  by  Thos.  T.  Sabine  ; 
Dupuytren's  Contraction  of  Fingers,  (two  illus- 
trations) by  Robt.  Abbe ;  The  Pathological 
Anatomy  of  a  C«ise  of  Spinal  Caries  with 
Paraplegia,  (two  illustrations)  by  V.  P.  Gibney  ; 
the  History  of  Three  Cases  of  Hip  Disease  in 
Third  Stage  (nine  illustrations)  by  A.  B.  Jud- 
son ;  Skin-Grafting  (two  illustrations)  by  G. 
A.  Van  Wagenen.  Contributions  are  solicited 
from  all  quarters.  "  Every  accepted  article 
will  be  paid  for,  and  the  toater  colours  (6  +  9 
inches),  photographs,  and  drawings  will  be 
reproduced  without  ex],)6nse  to  contributors." 


180 


CANADIAN  JOURNAL  OF  MEDICAL  SCIENCE. 


Diseasss  of  Women :  including  their  Pathology 
Causation,  Symptoms,  Diagnosis,  and  Treat- 
ment. A  Manual  for  Stitdents  and  Practi- 
tioners. By  Arthur  W.  Edis,  M.D.,Lond., 
F.R.C.P.,  M.R.C.S.,  Assistant  Obstetric 
Physician  to  the  Middlesex  Hospital.  With 
14S  illustrations.  Philadelphia:  Henry  C. 
Lea's  Son  &  Co.  1882. 
To  the  reader  of  current  English  Gynaecolo- 
gical periodical  literature,  the  high  excellence 
of  this  latest  manual  on  the  Diseases  of  Women 
will  not  be  a  matter  of  surprise,  for  to  him  the 
author  of  the  present  treatise  will  be  well  and 
favoui-ably  known.  Among  British  works 
upon  the  subject,  so  far  as  we  are  acquainted 
with  them,  and  we  think  we  are  familiar  with  the 
chief,  that  of  Barnes  alone  will  bear  favourable 
comparison  with  this  the  latest,  and  perhaps, 
for  students'  purposes,  the  best.  But  it  would* 
in  truth,  be  doing  violence  to  the  fact  to  affirm 
that  the  present  work  is  at  all  capable  of  super- 
seding the  crowning  triumphs  of  American 
industry  and  genius  in  this  field,  the  justly 
valued  works  of  Thomas  and  of  Emmet.  The 
present  volume  is  divided  into  37  chapters, 
occupying  something  over  500  pages.  It  will 
be  seen,  therefore,  that  a  large  amount  of 
information  lias  had  to  be  compressed  within 
a  comparatively  small  space,  for  the  work  has 
been  brought  fairly  well  up  to  date,  and  yet, 
withal,  lucidity  has  been  by  no  means  lost  in 
conciseness  and  condensation.  The  illustra- 
tions are,  for  the  most  part,  very  good,  being  as 
the  author  says  "chiefly  outline  diagrams," 
and  the  instrumental  armamentarium  has  not 
been  overlooked  or  neglected.  Barnes  and 
Thomas,  with  due  acknowledgements,  have 
been  largely  drawn  upon,  and  the  author  has 
succeeded  in  producing  a  very  complete,  inter- 
esting, and  instructive  compend  of  the  wide 
and  difficult  subject  of  which  he  treats.  If 
called  upon  to  select  any  portion  of  the  work 
as  being  of  higher  excellence  than  the  rest, 
we  should  point  to  the  section  on  Abdominal 
Tumours  as  deserving  of  the  highest  com- 
mendation. We  do  not  know  that  we  have 
any  special,  particular  fault  to  find  with  any 
part,  but  had  intended  to  do  a  little  criticism 
of  the  chapters  seriatim.  Lack  of  space  in 
this  issue,  however,  forbids.  The  merits  of  the 
book  are  neverthless,  so  high  that  we  do  not 
hesitate  to  give  it  generally  the  strongest 
recommendations  to  our  readers. 


^im\lmto\x^» 


Hygienic  Measures. — It  will  be  a  source 
of  gratification  to  know  in  future  that  the 
medical  profession  has  always  stood  in  the 
front  rank  in  the  fight  for  the  prevention  of 
sickness.  The  fight  will  be  a  long  one  before 
the  theory  of  humanism  will  be  fully  practised. 
It  is  true  that  it  is  no  longer  lawful  to  throw 
away  new-born  babies  that  were  not  washed, 
or  throw  to  the  bloodhounds  the  old,  infirm, 
and  moribund;  but  the  study  of  what  occurs 
every  day,  socially,  publicly,  officially,  in  the 
course  of  life,  within  the  limits  of  law,  under 
the  rules  governing  industry  and  commerce, 
amongst  the  luxuriously  rich  and  the  abject 
poor,  is  still  apt  to  make  the  humanitarian 
weep  and  the  moralist  blush. 

"To  live  fast  and  in  enjoyment,  though  to 
one's  injury,  is  better  than  to  live  in  health 
long  and  sedulously.  What  is  .most  to  be 
feared  is  overpopulation  and  increasing  com- 
petition. There  is  no  harm  in  epidemics  and 
wars  cutting  off  the  population  annually  ;  for, 
such  is  the  charter  of  our  times.  The  enthu- 
siasts in  the  cause  of  public  hygiene  fight  a 
battle,  the  aim  of  which  is  too  high  for  me  to 
see.  In  that  respect  I  am  myopic.  I  may 
admire  the  battle  but  I  cannot  sympathize  with 
it." 

Who  says  that  1  A  man  who  has  been  able 
to  prove  that  supplying  the  medical  profession 
of  the  world  with  books,  and  some  good  books, 
of  performing  old  operations  skillfully  and  de- 
vising new  ones,  does  not  redeem  him  from 
coarse  thinking,  brutal  feeling,  and  vulgar 
talking — does  not  make  a  noble  physician  out 
of  a  mere  operator  and  literary  man.  His 
name,  I  am  sorry  to  say,  is  Billroth.  Through 
him  New  York  fanaticism  will  feel  amply 
justified  in  trying  to  provj  that  the  whole 
profession  is  imbued  with  the  spirit  of  egotism 
and  barbarism.  In  the  face  of  such  shocking 
vulgarity,  in  the  presence  of  the  noble  profes- 
sion of  the  State  of  New  York,  in  the  remem- 
brance of  the  tendencies  and  aims  of  the  most 
humanitarian  profession  in  existence,  I  may  be 
permitted  to  ask  your  co-operation  in  measures 
looking  toward  the  cure  of  disease  and  the 
amelioration  of  the  suffering  of  human  kind. — 
An  Extract  from  Jacobi's  Presidential  Address, 
Medical  Society,  State  of  New  York. 


THE 


\<A 


dtanabian  |0urnal  of  Mebkal  ^rimce. 


A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


U.  OGDEN,  M.D., 

R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond 


I  Consulting  Editors.     I         *"  "•  BRIGHT.  B.A..  M.B.,  M.R.C.S..  Eng..  )  Editor*. 
., )  I         I.  H.  CAMERON,  M.B.,  ' 


SUBSCRIPTION,   $3    PER    ANNUM. 


1^  All  literary  oommunications  and  Szchanges  should  be  addressed  to  Dr.  OAMZRON,  278  Sherbotime  St. ; 

or,  Dr.  WRIGHT,  312  Jarvis  St. 
aS"  All  business  communications  and  remittances  should  be  addressed  to   HART  ft  COMPANY,  Publishers, 

31  and  33  King  Street,  Toronto. 


TORONTO,  JUNE,  1882. 


CLINICAL  LECTURE  ON  ACUTE 
BRIGHT'S  DISEASE. 

BY  WM.  OSLER,    M.D.,  M.R.C.P.,    LOND.,  PROFESSOR 
OF    PHYSIOLOGY    m'gILL    MEDICAL   FACULTY. 

Delivered  at  the  meeting  in  the  Summer  Session. 

Gentlemen, — Since  I  took  charge  of  the 
wards  you  have  had  opportunities  of  studying 
three  cases  of  acute  nephritis,  and  to-day  I 
propose  that  we  shall  go  over  them  together, 
and  see  what  lessons  we  can  learn  about  this 
important  affection.  And  first  let  me  remark 
that  under  the  common  designation  Morbus 
Brightii,  several  separate  diseases  must  be 
distinguished  ;  a  good  natural  classification  is 
as  follows  : — 

I.  Acuto  Bright's  disease,  acute  parenchy- 
matous nephritis. 

II.  Chronic  Bright's  disease. 

(1)  Chronic  parenchymatous  nephritis. 

(2)  Interstitial  nephritis. 

(3)  Amyloid  disease. 

(4)  Mixed  forms. 

The  cases  are  briefly  as  follows  : — 
Case  I. — Scarlet  fever — Acute  renal  dropsy 
— Death. 

W.  M.,  est.  13.  Admitted  Feb.  9th,  under 
Dr.  Ross,  with  dropsy  and  shortness  of  breatli. 
Was  healthy  a  year  ago.  Had  mild  scarlet 
fever,  and  souiB  time  after  it  began  to  have 
severe  headaches,  and  the  feet  became  swollen 
in  the  evenings.  In  November  he  quit  school 
and  has  been  laid  up  ever  since.  Dr.  Blackader, 
under  whose  care  he  was,  states  that  the  chief 
symptoms  have  been,  up  to  the  date  of  admis- 
sion, headaches  and  dropsy,  which  sometimes 


would  become  general.  Uriue  has  been 
albuminous,  and  contained  blood  and  casts. 
When  admitted,  was  pale,  and  had  cedema  of 
feet  and  legs ;  no  fluid  in  abdomen  ;  slight 
dullness,  with  r&les  at  right  base.  Urine 
scanty,  6  ozs.,  smoky ;  sp.  gr.,  1020  ;  contained 
much  albumen,  finely  granular  and  epithelial 
casts,  with  blood  cells.  T.,  99.5;  P.,  132;  R., 
142.  Ordered  milk  diet,  and  Liq.  Amm.  Acet. 
5ii,  with  Inf.  Digital,  5ii.  every  four  hours,  and 
a  few  days  after  pilocarpine,  one-eighth  of  a 
grain,  which  produced  salivation  and  copious 
sweating.  By  the  17th  the  swelling  of  the 
legs  had  subsided,  but  eyelids  were  puffy ; 
urine  clear  and  more  abundant,  50  ozs.  Up  to 
the  end  of  the  month,  patient  varied ;  on  the 
22Dd  urine  was  again  bloody,  and  the  loins  wei'e 
cupped ;  pilocarpine  continued  at  intervals. 
Early  in  March  was  not  so  well.  General 
oedema  came  on,  with  great  oppression  of 
breathing.  A  systolic  murmur  has  been  heard 
at  apex  for  a  couple  of  weeks.  Hot  air  bath 
caused  much  restlessness.  The  urine  varied 
much  ;  was  at  times  very  bloody  and  again 
clear.  On  the  17th  the  oedema  became  more 
intense ;  urine  scanty,  14  to  15  ozs.  ;  much 
albumen.  Was  taken  home  on  the  t2nd,  and 
died  about  the  1st  of  April. 

Case  II. — Mary  C,  set.  8.  Admitted  March 
6th,  under  Dr.  Ross,  with  severe  vomiting^ 
headache  and  slight  swelling  of  feet  and  legs. 
Taken  ill  on  4th,  two  days  before  admission. 
Child  had  scarlet  fever  over  a  year  ago ; 
recovered  completely,  and  has  been  strong  and 
well  since.  Had  mumps  thr3e  weeks  ago.  On 
above  day  (4th),  had  been  out  and  exposed; 
complained  of  boots  being  tight;  legs  were 
found  slightly  swollen.     On  the  evening  of  the 


182 


CANADIAN  JOURNAL 


6th  was  restless,  and  had  headache,   vomiting 
and  nose-bleoding. 

On  admission,  puffiness  of  eyelids,  moderate 
oedema  of  feet  and  legs,  headache  and  vomiting. 
Passed  28  oza.  of  urine  in  20  hours ;  dark, 
smoky,  large  amount  of  deposit ;  sp.  gr.,  1015: 
albumen  abundant.  Microscope  gave  casts, 
hyaline  and  epithelial,  and  many  free  blood 
cells.  Heart  beat  strong  ;  a  soft  bellows  mur- 
mur in  4th  interspace,  close  to  sternum.  Had 
mustard  and  linseed  poultices  to  loins.  Next 
day  cupped,  and  ordered  Liq.  Amra.  Acet.  and 
Inf.  Digital,  aa  5ii  every  four  hours.  By  9th, 
vomiting,  nose  bleed,  and  headache  had  stopped; 
oedema  less  ;  urine  more  abundant,  35  ozs.  of 
same  characters.  Ordered  hot  air  bath  every 
evening.  By  11th,  urine  61  oz9.,  still  dark, 
but  not  so  bloody.  Hot  air  bath  has  acted 
very  well.  General  symptoms  improved.  On 
13th,  65  ozs.  of  urine,  smoky,  but  not  very 
dark ;  contains  less  albumen ;  very  few  casts ; 
cadema  gone.  Temperature  which  has  ranged 
from  100  to  100.5°,  is  now  normal.  On  18th 
hardly  a  trace  of  albumen,  about  62  ozs.  daily, 
still  a  little  smoky  ;  granular  casts.  Hot  aip 
baths  to  be  stopped,  also  the  Digital,  and  Liq. 
Amm.  Acet.,  and  Basham's  Mixture  (Tinct. 
Ferri  Muri,,  Acetic  Acid  and  Liq.  Amm.  Acet.) 
substituted.  On  night  of  20th,  not  so  well ; 
not  so  much  urine,  40  ozs.,  and  darker  ;  many 
granular  casts.  Improved  until  April  9th,  to 
which  date  urine  ranged  from  40  to  65  ozs.  ; 
sp.  about  1010.  On  April  11th,  urine  again 
a  little  reddish  and  albuminous;  child  appears 
quite  well,  but  is  a  little  feverish.  Went  out 
on  13th.  A  few  days  ago  she  came  to  report 
herself  as  continuing  well. 

Case  III.* — James  B.,  set.  23,  a  well-built 
labourer.  Admitted  April  26th,  with  dropsy. 
Nothing  of  note  in  family  or  pensonal  history. 
Has  been  working  on  the  railroad.  One 
Sunday,  about  three  weeks  ago,  he  went  with 
some  comrades  to  a  village  seven  miles  distant 
and  drank  heavily.  On  returning  to  the  shanty 
that  night  he  was  unable  to  keep  up  with  his 
companions,  and  laid  down  on  the  snow  for 
some  hours,  until  his  friends  returned  for  him. 
The  next  day  he  had  a  slight  chill  with   pains 

"Report  by  Mr.  J.  R.  Johnson. 


in  the  back  and  in  the  left  side.  These 
continued  for  three  or  four  days,  and  he  then 
noticed  that  his  face  was  puffy,  and  the  hands 
and  legs  began  to  swell.  He  does  not  remember 
about  the  urine  ;  thinks  he  passed  as  much  as 
usual.  Had  no  vomiting,  no  headache.  On 
admission,  feet  and  legs  oedematous,  the  left 
more  than  the  right ;  face  swollen.  Nothing 
special  detected  in  examination  of  heart  and 
lungs.  Tongue  coated ;  appetite  impaired. 
Urine — amount  for  first  24  hours  in  which  it 
was  collected,  46  ozs. ;  brownish  red  color, 
smoky,  acid  reaction;  sp.  gr.,  1016;  contains 
a  large  amount  of  albumen,  and  on  micro- 
scopical examination  presents  red  blood  cor- 
puscles and  numerous  casts  of  which  three 
varieties  .have  been  detected — (a)  hyaline,  with 
a  few  scattered  granules  ;  (6)  epithelial  casts,  or 
rather  cylinders  with  round  cells,  resembling 
leucocytes ;  (c)  blood  casts,  composed  chiefly  of 
red  blood  corpuscles.  Of  these  the  delicate  hya- 
line casts  have  been  most  abundant.  For  four 
days  we  kept  him  in  bed,  on  a  light  diet,  with 
out  any  special  treatment  and  since  that  date 
he  has  had  a  couple  of  jalap  powders  to  keep  the 
bowels  loose.  .  The  oedema  of  the  face  is  gone, 
the  legs  are  less  swollen,  while  the  amount  of 
urine  is  about  the  normal,  containing  very 
little  blood  and  less  albumen ;  the  urea,  how- 
ever, is  diminished.  The  man  has  been  able  to 
walk  upstairs  and  has  done  remarkably  well. 

You  will  notice  that  these  three  cases 
present  a  striking  uniformity  in  the  chief 
symptoms — alterations  in  the  character  of  the 
urine,  with  dropsy  ;  hence  the  appropriateness 
of  the  old  term.  Acute  Renal  Dropsy. 

Let  us  now  briefly  review  the  affection,  as 
illustrated  by  our  cases.  ^Etiology — It  is  a 
disease  of  early  life ;  the  great  proportion  of 
the  cases  are  in  persons  under  20,  and  as  the 
years   increase,  the   less  frequently  it  is  met 

with.     The  cage  of  Prof.  ,  who,  nearly 

ten  years  ago,  at  the  age  of  about  fifty,  had 
acute  nephritis,  and  in  whose. con  tinned  good 
health  we  now  rejoice,  is  an  instance  of  the 
occurrence  of  this  disease  at  an  unusually  late 
period  of  life.  Scarlet  fever  and  cold  were  the 
causes  which  prevailed  in  our  cases,  and  these 
obtain  in  the  majoi'ity  of  individuals  attacked. 
It  is.  one  of  the  most  dreaded  sequelae  of  scarlet 


OF  MEDICAL  SCIENCE. 


183 


fever,  and  as  in  the  boy  M — ,  not  infrequently 
follows  an  attack  which  is  bo  trivial  as  to  be 
almost  overlooked.  Diphtheria  is  an  occasional 
cause,  and  the  other  infectious  diseases  may  at 
times  be  followed  by  an  acute  inflammation  of 
the  kidneys.  After  cold  and  scarlet  fever,  you 
will  find,  as  practitioners,  that  pregnancy  comes 
next  in  order  of  frequency  in  inducing  this 
affection.  How  it  does  so  we  need  not  stop 
here  to  inquire,  the  explanations  usually 
offered  are  not  altogether  satisfactory. 

The  morbid  anatomy  has  been  much  dis- 
cussed. In  the  early  stage  we  do  not  often 
have  an  opportunity  of  dissecting  the  organs, 
but  doubtless  we  would  find  them  congested 
and  swollen.  At  the  period  in  which  we  com- 
monly inspect  them — from  three  weeks  to 
three  months  after  the  onset — the  organs  are 
much  enlarged,  weigh  8  to  10  ozs,,  and  have 
the  appearances  known  as  characteristic  of  the 
*'  large  smooth  kidney,"  or  the  mottled  kidney. 
The  capsule  is  thin,  and  strips  off  easily ;  on 
section,  the  cortex  is  seen  to  be  increased  in 
thickness  and  anaemic,  or  of  an  opaque  yellow- 
white  aspect ;  the  Malpighian  tufts  and  the 
arterial  twigs  are  injected,  as  are  also  the  large 
collecting  veins  which  convey  the  blood  from 
the  stellate  veins  of  the  surface.  The  pyramids 
are  usually  congested,  and  offer  a  striking 
contrast  to  the  pale  cortex.  The  histological 
changes  are  chiefly  in  the  cortical  parts,  and 
consist  in  swelling  of  the  epithelium,  which 
becomes  more  granular,  and  may  degenerate 
into  a  molecular  debris,  distending  the  tubules. 
Other  tubes  may  contain  blood-cells  and 
leucocytes,  with  casts.  In  later  stages,  fatty 
changes  may  cause  patchy  opacities.  Inter- 
tubular  changes,  in  the  fprm  of  connective 
tissue  proliferation,  have  also  been  described, 
and  probably  always  take  place  in  cases  which 
last  several  months.  These  have  been  specially 
described  by  Klein  in  the  scarlatinal  form. 
Bowman's  capsule  and  the  contained  glomerulus 
are  also  involved.  Klebs  first  called  attention 
to  these  changes  (glomerulo-nephritis),  but  he 
believed  them  to  be  entirely  of  the  nature  of 
proliferation  of  the  cells  between  the  capillary 
coils.  Probably  the  epithelial  coating,  as  well 
as  capsulary  epithelium,  is  affected.  I  pass 
round  the  Langhans  plate  (Virchow's  Archiv., 


Bd.  76),  in  which  these  changes  are  well 
figured. 

Symptoms. — In  the  majority  of  cases  the  ap- 
pearance of  cedema  gives  the  first  indication 
to  patient  or  doctor.  In  the  man  B — ,  a 
slight  chill,  with  feverishness  and  lumbar  pain, 
preceded  the  oedema.  In  case  I,  persistent 
headaches  appear  to  have  accompanied  the 
onset ;  and  in  case  IT,  which  followed  cold, 
headache  and  vomiting  were  the  first  symptoms. 
The  latter  is  not  infrequent  in  the  early  stage 
of  scarlatinal  nephritis.  The  most  marked 
feature,  dropsy,  may  vary  from  merepuffiness 
of  the  eyelids  and  oedema  of  the  ankles  to  ex- 
tensive general  anasarca,  with  exudation  into 
the  serous  sacs.  The  milder  grade  you  see  in 
this  man  (case  III) ;  the  more  intense  you 
witnessed  in  the  boy  M — . 

The  alterations  in  the  urine  are  of  the  ut- 
most importance.  In  the  early  stage  it  is 
reduced  in  quantity,  may  be  only  a  few  ounces, 
or  the  secretion  may  even  be  suppressed.  The 
colour  is  increased,  usually  dark  red,  from 
admixture  with  blood ;  very  commonly  it  has  a 
smoky,  lake  colour,  very  characteristic  of  the 
presence  of  blood,  and  which  resembles  a 
dilute  solution  of  reduced  haemoglobin.  Che 
various  shades  of  intensity  of  this  you  have 
had  an  opportunity  of  seeing  in  case  III.  The 
blood  may  disappear  and  then  recur,  as  it  did 
in  cases  I.  and  II.  The  specific  gravity  is  in- 
creased at  first,  1020  to  1030,  owing  to  the 
relatively  small  amount  of  water.  When  the 
quantity  rises  to  normal,  the  specific  gravity 
is,  as  a  rule,  lowered.  On  standing,  a  copious 
sediment  usually  falls,  reddish  or  reddish- 
brown  in  colour,  and  consisting  of  blood  and 
urates.  Chemically,  the  most  striking  change 
is  in  the  presence  of  albumen  when  you  heat 
the  urine  in  a  test  tube,  or  add  cold  nitric  acid. 
So  much  may  be  present  that  the  urine 
solidifies,  and  50  to  60  %  by  bulk  is  not  un- 
common. The  urea  is  diminished  in  amount. 
In  case  III,  the  estimates  made  by  Messra 
Renner  and  Gooding  with  Dupr^'s  apparatus 
give  28th,  46  ozs.  287  grs.;  29th,  70  ozs. 
403  grs.;  30th,  55  ozs.  250  grs.;  2nd,  68  ozd. 
228  grs.;  3rd,  63  ozs.  257  grs.;  4th,  66  ozs. 
247    grs. 

The  normal  amount  for  the  24  hours  is  between 


184 


CANADIAN  JOURNAL 


400  and  500  grs.,  and  an  a2)proach  to  this  or  an 
excess  is  a  happy  indication.  A  material  re- 
duction is  to  be  feared,  as  ursemia  is  apt  to 
follow. 

Tube  casts  furnish  important  evidence  in 
this  disease,  and  their  recognition  is  one  of  the 
earliest  lessons  which  you  should  learn  in 
clinical  microscopy.  Their  characters  have 
been  well  marked  in  this  man  (Case  III.) 
When  first  examined  a  few  well-formed  blood 
casts  were  seen ;  cylinders  or  moulds  of  the 
tubules  made  up  of  blood  corpuscles  imbedded 
in  an  indifierent  matrix.  Hyaline  or  faintly 
granular  have  been  the  most  abundant  forms, 
very  delicate  and  translucent,  so  that  the  in- 
experienced amongst  you  have  had  difficulty 
in  seeing  them  ;  and  thirdly,  epithelial  casts  not 
very  numerous,  but  commonly  consisting  of 
a  hyaline  cylinder,  with  a  few  granular  cells 
imbedded  in  it.  I  called  the  attention  of  some 
of  you  to  a  form  of  cast,  consisting  almost 
entirely  of  rounded  cells,  like  colourless  blood- 
corpuscles — leucocytes ;  this.  Dr.  George  John- 
son believes,  is  a  variety  met  with  when  a 
glomerulo-nephritis  is  present. 

The  varied  course  of  the  disease  is  well  illus- 
trated by  the  first  two  cases,  one  of  which  went 
from  bad  to  worse,  while  the  other  rapidly  im- 
proved. The  first  six  months  in  the  majority 
of  instances  concludes  the  case  one  way  or  the 
other.  Not  that  recovery  is  impossible  after 
this  date,  but  it  is  more  uncertain,  and  the 
chance  is  great  of  permament  damage  to  the 
organs  and  of  the  establishment  of  chronic 
parenchymatous  nephritis.  The  favourable 
signs  are  diminution  and  disappearance  of  the 
dropsy,  increase  in  the  amount  of  urine,  with  re- 
duction in  albumen  and  maintenance  of  norifial 
urea  excretion.  In  the  most  rapid  cases  three 
or  four  weeks  at  least  are  necessary  before  the 
condition  of  the  urine  becomes  normal.  I  have 
known  the  albumen  to  disappear,  while  the 
tube  casts  continued.  Circumstances  which 
warrant  unfavourable  prognosis  are  long  dura- 
tion, persistence  of  the  albumen  in  large  amount, 
material  reduction  in  urta  and  the  onset  of 
symptoms  of  ursemia,  some  of  which  may  be 
sudden  and  rapidly  fatal. 

What  are  the  indications  for  treatment  1 
Mild   cases  would    probably  recover;   indeed 


have  done  so,  left  to  nature.  Case  III.  received 
no  special  treatment  for  four  days,  and  improved 
during  this  time.  The  rest  in  bed,  recumbency, 
and  the  quiet  do  much,  but  there  are  few  cases 
which  do  not  call  for  active  interference.  In 
the  early  stages,  where  the  congestion  of  the 
organ  is  marked,  the  urine  reduced  in  amount 
and  bloody,  and  the  lumbar  pain  jnesent,  dry 
cupping  the  loins  and  warm  fomentations  do 
much  good,  acting  as  derivatives.  You  know 
on  general  principles  that  the  first  thing  to  be 
done  with  an  acutely  inflamed  organ  or  part,  is 
to  give  it,  if  possible,  functional  rest.  With 
the  kidneys  this  is  impracticable,  but  we  can 
relieve  and  assist  them  in  various  ways.  A 
spare  diet  and  rest  diminish  the  amount  of 
solid  materials  to  be  excreted.  Purgatives  and 
diaphoretics  call  to  aid  the  bowels  and  skin, 
which  supplement  the  action  of  the  kidneys, 
and,  as  it  were,  help  them  in  a  friendly  way 
when  they  are  disabled.  In  the  early  stages 
and  in  mild  cases,  there  is  no  necessity  for 
severe  purgation.  Keep  the  bowels  loose  by  a 
daily  dose  of  Glauber's  Salts  (Soda  Sulph.  5  ss.), 
and  perhaps  an  occasional  Jalap  purge  (Pulv. 
Jalapse  Co.  5  ss.).  In  the  more  chronic  cases, 
where  the  dropsy  is  great  and  uraemia  threaten- 
ing, hydrogogue  cathartics  will  be  of  great 
service.  Of  diaphoretics,  the  one  in  common 
use  and  most  cfficacfous  is  jahorandi,  or  its 
active  principle,  pilocarpin  ;  of  the  former  may 
be  given  mx  of  the  FJ.  Ext.  every  two  hours 
until  copious  sweating  is  induced  ;  of  the  latter 
a  hypodermic  injection  of  -j'-g-  to  ^  gr.  But  of 
all  measures  at  our  disposal  to  produce  sweat- 
ing, the  hot  air  hath  is,  in  my  experience,  the 
best,  the  easiest  employed,  and  has  the  addi- 
tional advantage  of  being  in  many  Instances  a 
diuretic,  so  that  after  a  most  copious  sweating 
the  amount  of  urine  for  the  twelve  or  sixteen 
hours  subsequent  may  be  actually  increased. 
On  our  return  to  the  ward  we  shall  give  our 
]>atient  B.  such  a  bath  that  you  may  see  the 
ease  with  which  it  is  applied.  Some  of  you 
may  remember  two  sessions  ago  the  case  of  a 
little  girl  in  the  children's  ward  with  acute 
renal  dropsy,  and  how  admirably  the  air  baths 
acted  without  any  medication.  The  warm 
baths  are  much  used  in  some  hospitals,  but 
they  are  inconvenient.   The  wet  pack,  wrapping 


OF  MEDICAL  SCIENCE. 


185 


in  a  wet  sheet  and  rolling  in  blank©ts_  is  un- 
pleasant for  the  patient,  and  has  no  special 
advantage.  What  about  diuretics?  In  the 
early  stage,  with  active  congestion  and  bloody 
urine,  no ;  but  later  they  may  be  advantageously 
employed,  and  good  fresh  water  may  be  taken 
freely  and  often  answers  the  purpose.  It  is  of 
importance  to  keep  up  the  amount  of  urine  for 
two  reasons ;  first,  the  larger  the  quantity  the 
more  solid  matter  will  be  removed ;  and  second, 
the  tubuli  urinifeH  are  thereby  flushed  (Dicken- 
son), the  debris  washed  out,  and  choking  of  the 
renal  drains  is  in  this  way  prevented.  If  a 
special  diuretic  is  indicated,  the  Inf.  Digitalis 
as  used  in  cases  I.  and  II.  may  be  given.  The 
diet  should  be  light  and  nutritious ;  not  much 
meat.  Milk  is  much  used  in  these  cases,  and 
the  diet  may  be  restricted  to  it  as  in  case  I. 


OVARIOTOMY.— FIVE  CASES. 

DR.   W.  T.  AIKINS,  TORONTO. 

Case  No.  1.— Under  care  of  Dr.  George 
Hodge.  Miss  H.,  of  Mitchell,  Ontario,  set. 
30,  greatly  reduced  in  health  and  strength  by 
a  peritoneal  inflammatory  attack.  Was  tapped 
Oct.  16Lh.,  1880,  as  a  ^means  of  gaining  time, 
affording  relief,  and  eflecting  a  general  improve- 
ment   in   her   condition.      1880,    Oct.   29th. 

Health  considerably  improved.^^Operated  at 
her  home  in  Mitchell,  ably  assisted  by  Drs. 
Hodge  and  Lehman.  Multilocular  right  ovarian 
cyst  removed.  Adhesions  anteriorly  and  to  the 
omentum,  somewhat  extensive,  though  yield- 
ing readily.  Pedicle  cauterized.  Several  bleed- 
ing points  in  omentum  tied  with  carbolised 
catgut.  Owing  to  oozing  from  abdominal  walls, 
and  to  some  of  the  cyst  contents  ^falling  into 
the  abdominal  cavity,  the  pelvis  and  adjoining 
peritoneum  were  very  carefully  sponged,  and 
glass  drainage  tube  inserted.  Deep  sutures  of 
silkworm-gut  (embracing  skin,  muscle,  and 
peritoneum),  and  superficial  intervening  ones  of 
catgut  —Lister's  dressings. 

Temperature  at  midnight,  1005°  F.  (highest); 
fell  to  100°  on  first,  and  to  normal  on  second 
day.  Pulse  four  hours  after  operation  128, 
twenty-four  hours  later  114,  second  day  84. 
Very  slight  vomiting  towards  evening,  urinated 


freely  at  8  p.m.  Was  given  \  gr.  morphia. 
Passed  comfortable  night.  For  twenty -four 
hours  following  operation  had  no  food  and  only 
a  few  teaspoonsful  of  hot  water.  Sponge  over 
drainage  tube  found  wholly  free  from  fluid  at 
each  of  the  early  dressings,  tube  therefore 
removed.  Patient  made  a  rapid  recovery  and 
is  now  in  good  health. 

I  feel  under  great  obligations  to  the  care  and 
good  judgment  of  Dr.  Hodge  in  the  manage- 
ment of  this  case. 

Case  No.  2.— Miss  W.,  Toronto,  at.  22, 
patient  of  Dr.  Thomas  Hobley.  Abdominal 
enlargement  first  noticed  in  the  winter  of 
1879-80;  health  began  to  fail  in  spring; 
in  summer  was  confined  to  house  and 
bed.  For  many  months  preceding  opera 
tion  patient  almost  waxy  pale,  emaciated,  very 
weak,  and  suffering  from  amenorrhoea  and  ele- 
vation of  temperature.  Was  tapped  by  Dr. 
Hobley  about  October  16th,  1880;  a  decided 
improvement  in  her  health  resulting. 

November  6th,  1880. — Operated  at  her  own 
residecce  in  Toronto,  assisted  by  Drs.  Hobley, 
U.  Ogden  and  Watt,  Multilocular  tumor  of 
left  ovary  removed ;  pedicle  cauterized ; 
troublesome  oozing  from  adhesions,  high  up 
anteriorly,  necessitating  extension  of  abdominal 
incision ;  drainage,  sutures,  and  dressings  as 
in  previous  case.  Patient  was  placed  in  bed 
pale  and  weak  ;  foot  of  bedstead  raised  fifteen 
inches.  Temperature  on  November  6th,  7th, 
and  8th,  100°,  101°,  9th  falling,  10th  normal. 
Pulse  for  three  days  following  operation  from 
150  to  130,  fourth  112;  sixth  day  106  and 
falling. 

Nine  houis  after  operation  had  ^  gr.  morphia 
being  restless  and  wakeful.  No  vomiting  at 
all ;  no  food,  and  only  one  ounce  hot  water  for 
twenty-four  hours.  For  several  days  dark 
coloured  serous  fluid  continued  to  come  up 
through  drainage  tube,  necessitating  the  change 
of  the  sponge. 

On  second  day  was  ordered  quin.,  sulph.,  gr. 
ij.  and  tr.  digitalis,  m.  xv — ter.  in  die.  Bowels 
moved  tor  firdt  time  on  sixth  day.  Patient 
improved  slowly. 

May  20th,  1882.— Patient  to-day  is  "better 
than  ever  before  in  her  life." 

Case  No.  3. — Mi-s.  H.  G.,  Harriston,  set.  38. 


186 


CANADIAN  JOURNAL 


January  4th,  1882 — Examined,  and  found 
single  ovarian  cyst,  present  over  two  years ; 
growing  rapidly  diu-ing  last  six  months  ;  no 
oedema  in  lower  extremities ;  no  vomiting ; 
tumor  apparently  uniform.  Pulse  and  tem- 
perature normal. 

February  28th,  1882 —assisted  by  Drs.  U. 
Ogden,  A.  H.  Wright,  and  I.  H.  Cameron, 
operated  in  private  boarding  house,  Toronto. 
Single  cyst  of  left  ovary  removed;  entirely  free 
from  adhesions,  pedicle  cauterized  ;  no  drainage 
tube  ;  Lister's  dressings.  Temperature  at  mid- 
night 99-4,  first  day  100°  to  lOT  (highest) 
second  day  99-8,  fourth  day  99,  subsequently 
normal.  Pulse  ranged  for  first  four  days  from 
90  to  100,  fulling  afterwards.  Respirations 
slightly  increased  for  a  day  or  two.  Morphia, 
food,  and  drink  as  in  other  cases.  Patient 
continued  to  improve. 

April  25th,  1882. — Her  husband  writes  me, 
"  Mrs.  G.  is  improving  in  strength,  and  has 
been  out  to  church." 

Case  No.  4.— Miss  E.  S.,  set.  30,  County 
of  Bruce.  Health  became  impaired  in  July 
1881  ;  had  had  " inflammation  of  the  bowels" 
before  that.  Has  been  losing  flesh  and  is  of 
poor  colour.  Admitted  into  Toronto  General 
Hospital  under  my  care,  January  1882,  with 
subacute  peritonitis,  tenderness  on  pressure ; 
temperature  101"  ;  kept  her  bed  until  all 
tenderness  had  subsided,  and  temperature 
was  normal. 

March  7th,  1882. — Operated  in  a  private 
ward  in  the  Toronto  General  Hospital. 
Pedicle  in  this  case  about  ten  inches  in  length, 
lying  along  anterior  and  upper  surfaces 
of  cyst,  and  adherent  throughout,  a  condition 
apparently  due  to  the  tumor  having  at  an  early 
stage  in  its  growth,  when  by  gravity  it  lay  in 
Douglas's  pouch,  contracted  very  firm  ad- 
hesions, to  a  portion  of  the  floor  of  the  pelvis, 
and  to  the  whole  of  the  posterior  wall  of  tho 
uterus.  This  portiion  of  the  cyst  was  not 
removable ;  was  severed  from  the  rest  of  the 
tumor,  its  edges  secured  against  haemorrhage,  by 
ligatures  and  then  made  to  surround  a  drainage 
tube  placed  in  its  cavity,  and  finally  stitched 
to  the  edges  of  the  incision  in  the  abdominal 
wall ;  a  second  drainage  tube  inserted  into 
peritoneal  cavity,  reaching  to  floor  of  pelvis ; 


pedicle  tied  with  silk ;  sutures  and  dressings 
as  in  other  cases.  Temperature  for  36  hours 
satisfactory ;  afterwards  it  rose  steadily.  Pulse 
immediately  following  operation  120  ;  did  not 
afterwards  fall  below  this.  Nutrient  ene- 
raata  were  given  and  retained  from  very  shortly 
after  operation  every  two  or  three  hours,  caus- 
ing no  inconvenience,  but  relieving  thirst. 
Some  unavoidable  haemorrhage  at  time  of 
operation,  none  afterwards ;  no  vomiting  ; 
shock  from  operatian  not  great ;  patient  died 
sixty  hours  after  operation.  Post-mortem 
revealed  full  evidences  of  peritonitis. 

Case  No.  5. — Mrs.  T.,  of  Dunsford,  aet.  31  ; 
at  present  a  patient  of  Dr.  W.  W.  Ogden, 
of  Toronto..  Married  February,  1877.  In 
December  1877,  when  seven  months  preg- 
nant with  first  child,  had  a  severe  fall,  followed 
shortly  afterwards  by  a  premature  labor.  In 
June  1878  was  noticeably  stouter  than  she 
should  have  been;  in  April  1879  was  confined 
with  full-grown  child,  but  her  "  size,  was 
very  little  smaller  after  labor  than  before  ;" 
in  September,  1880  was  again  delivered  at 
terfn,  but  "  after  the  labor  was  nearly  as  stout 
as  before  it;"  in  1881  was  tapped  by  her 
medical  attendant  in  Lindsay  ;  in  March  1882 
was  again  tapped  by  Dr.  W.  W.  Ogden,  of 
Toronto. 

April  25th,  1882.~Assisted  by  Drs.  W.  W. 
Ogden,  U.  Ogden,  Sweetnam,  and  H.  W. 
Aikins,  removed  multilocular  ovarian  cyst,  one 
cyst  largely  predominating  ;  pedicle  very  short; 
cauterized  ;  parietal  and  omental  adhesions 
anteriorly  separated  by  tearing,  with  little  sub 
sequent  oozing ;  drainage,  sutures  and  dressing 
as  before.  Temperature  for  first  24  hours  100°, 
lOr,  second  day  from  101-2"'  (highest)  to  99-6, 
for  six  or  eight  succeeding  days  it  ranged 
between  100°  and  normal.  Pulse  for  first  two 
days  in  neighbourhood  of  108,  third  day  90, 
fourth  day  80.  Respirations  for  several  days  ; 
slightly  increased  in  frequency.  For  24 
hours  following  operation :  no  vomiting,  no 
straining  ;  no  retching,  no  anodyne,  no  food, 
no  drink  ;  and  patient  generally  comfortable. 
At  first  dressing  sponge  over  drainage  tube 
saturated  with  fluid ;  pelvic  cavity  very 
gently  washed  out  with  carbolised  water ;  on 
second   and  third   days   sponge  free  from  fluid, 


OF  MEDICAL  SCIENCf:. 


187 


though  some  withdrawn  from  Douglas's  pouch; 
fourth  day  sponge  and  tube  removed ;  fifth 
day  enema  to  act  on  bowels ;  seventh  day  some 
sutures  removed,  eleventh  day  the  balance. 
Patient  now  (May  20ch,  1882),  twenty-five 
days  after  operation  has  not  had  one  unfavour- 
able symptom,  is  sitting  up  some  every  day, 
eating  heartily,  gaining  in  strength,  and  feeling 
in  every  way  comfortable. 

These  cases  constitute  the  last  five  upon 
which  I  have  operated,  and  have  been  selected 
as  having  occurred  subsequent  to  my  first  wit- 
nessing the  use  of  the  cautery  by  Mr.  Keith,  of 
Edinburgh,  in  the  early  fall  of  1880,  though, 
through  the  kindness  and  courtesy  of  London 
surgeons,  it  had  been  my  privilege  previously 
to  see  ovai'iotomies  by  Spencer  Wells,  Brjant, 
Bantock,  Thornton,  Sydney  Jones,  Carter  and 
and  Croft. 

In  the  four  successful  cases  above  narrated 
Baker  Brown's  Clamp  was  employed  till 
after  the  cauterizition ;  and  the  satisfactory 
progress  in  the^se  cases  endorses  the 
views  held  by  Mr.  Keith  so  strongly  in 
favour  of  the  cautery.  In  these  four  cases  I 
believe  Lister's  antiseptic  treatment  was  in 
every  respect  faithfully  carried  out.  The 
fatal  case  was  a  very  severe  one,  and 
might  have  terminated  fatally,  even  if  anti- 
septicism  in  the  treatment  had  been  perfect, 
which,  I  regret  to  say,  though  through  no  fault 
of  my  own,  it  was  not. 

One  is  a  little  stiprised  at  the  slight  elevation 
of  temperature  and  pulse  following  the  tearing 
asunder  of  adhesions  and  the  return  into  the 
pelvis  of  the  tissue  embraced  between  the 
blades  of  the  clamp,  killed  and  so  dried  by 
the  cautery  on  the  surface  of  the  clamp  as  to 
resemble  in  colour  and  thinness  a  fish's  fin, 
one  quarter  inch  wide  and  two  or  three  inches 
long. 

In  eachinstance  ether  was  administered  and  it 
is  satisfactory  to  know  that  in  none  of  the  cases 
was  there  any  unpleasant  disturbance  of  the 
stomach,  a  fact  which  may,  in  part,  be  attributed 
to  the  absence  of  food  from  this  organ  for 
many  hours  preceding  and  following  the  opera- 
tion. Bleeding  points  were  secured  with  car- 
bolised  catut  ligatures  or  by  torsion. 

The  pelvis  in  some  instances  was  very  care- 


fully sponged,  so  as  to  leave  it  as  far  as  possible 
perfectly  dry. 

Drainage  was  provided  for  by  the  use  of 
perforated  glass  tubes  through  which  any  fluid 
in  the  pelvis  could  pass  up  to  be  absorbed  by 
the  sponge,  or  withdrawn  by  the  syringe,  and 
through  which,  in  addition,  carbolised  water 
could   be  injected,   and  subsequently  removed. 

In  closing  the  external  wound,  deep  sutures  of 
silk-worm  gut,  and  superficial  intervening  ones 
of  catgut  were  employed,  though  I  believe  silk 
thread  boiled  for  two  or  three  hours  in  a  five 
per  cent,  solution  of  carbolic  acid,  and  kept  in 
the  same,  might  answer  just  as  well,  as  no 
suppuration  whatever  will  take  place  around 
the  threads  beneath  the  antiseptic  dressings. 
In  the  management  of  this  class  of  cases  a  few 
other  points  of  importance  upon  which  stress 
may  be  laid  are  here  simply  enumerated  : — 

Antecedent  tonic  treatment,  selection  of 
suitable,  roomy  apartment,  well  lighted,  well 
ventilated,  and  wholly  free  from  draughts,  of 
capable  assistants  at  the  time  of  the  operation, 
of  trained  attendants  subsequent  to  it,  the 
maintenance  of  an  equable  temperature,  the 
utmost  cleanliness  in  every  particular,  and  the 
minutest  attention  to  details  ;  perhaps  more 
than  any  anything  else  in  the  utmost  cleanli- 
ness of  the  hands,  and  the  conscientious  and 
intelligent  antiseptic  mangementof  the  sponges 
before  and  during  the  operation.  No  hand 
not  perfectly  aseptic  should  touch  a  sponge  ; 
no  sponge  not  perfectly  aseptic  should  ever 
be  introduced  into  the  living  human  abdominal 
cavity. 

In  these  remarks,  and  in  the  treatment 
of  my  cases,  I  claim  nothing  new,  and  only 
urge  what  has  already  been  more  forcibly 
insisted  on  by  the  great  ovariotomists  of 
Europe  and  America. 

The  Dublin  Journal  of  Medical  Science  says  : 
— "  It  is  related  of  the  late  Earl  of  Derby,  who 
was  a  martyr  to  gout,  that  on  one  occasion  a 
merchant  se  .t  him  a  supply  of  sherry,  inform- 
ing him  that  as  long  as  he  confined  himself  to 
it  he  would  continue  free  from  his  enemy ;  to 
which  the  statesman  laconically  replied  that 
'he  had  tasted  the  sherry  and  preferred  the 
gout.'" 


188 


CANADIAN  JOURNAL 


SOME  POINTS  OF  GENERAL  INTEREST 

IN  OPHTHALMOLOGY. 

(Paper  read  at  meeting  of  Toronto  Medical  Society, 
May  18th,  1882.) 

BY   R.    A.    BEKVE,    B.A.,    M.D., 

Lecturer  on  Diseases  of  the  Eye  and  Ear,  in  Toronto 

School  of  Medicine  ;  Oculist  and  Aurist  to 

Toronto  General  Hospital. 

The  value  of  the  ophthalmoscope  was  settled 
long  ago,  and  the  functions  of  ophthalmoscvjpy 
are  already  well  defined.  Invaluable  to  the 
ophthalmologist,  the  eye-mirror  is  of  undoubted 
service  to  the  general  practitioner,  both  for  pur- 
poses of  diagnosis  and  the  study  of  morbid  pro- 
cesses which  may  elucidate  those  beyond  direct 
observation.  The  relation  of  diseases  of  the 
eye  to  those  of  other  parts  of  the  system, 
and  various  points  in  ophthalmoscopy  having 
been  brought  up  from  time  to  time  in  our 
meetings,  a  brief  consideration  of  them  must 
suflfice  on  this  occasion. 

Optic  neuritis,  retinitis,  and  atrophy  of  the 
optic  nerve  are  the  principal  morbid  conditions 
at  the  fundus  claiming  general  attention  now  a- 
days.  It  is  worthy  of  note  that  there  may  bo 
excellent  vision  with  double  optic  neuritis,  and 
in  neuritis, retinitis,  and  choroiditis  pain  (ocular) 
is  generally  absent,  as  also  objective  symp- 
toms. Double  optic  neuritis*  depends  generally 
upon  coarse  intra-cranial  disease,  as  tumor, 
meningiti.s,  syphilitic  growths,  &c.,  but  gives  no 
sign  as  to  the  extent,  nature,  or  site  of  the  mis- 
chief; and  the  latter  may  last  for  months  or 
years  before  lighting  up  the  neuritis,  which 
again  may  be  transient.  Rarely,  brain  trouble 
causes  only  one-sided  neuritis,  but  the  latter  is 
generally  due  to  orbital  changes.  Occasionally 
double  optic  neuritis  occurs  in  morbus  Brightii 
.  with  cephalalgia  simulating  that  from  brain- 
tumor,  Ac.  Acute  myelitis  may  also  set  up 
neuritis.       Cerebral  disease  does  not  always  do 

80. 

There  is  generally  impaired  sight  in  optic 
neuritis,  and  though  this  may  improve,  it 
generally  deteriorates  as  secondary  atrophy  sets 
in.  The  latter  may  be  somewhat  difficult  in 
the  later  stages  to  distinguish  from  primary 
atrophy,  which  is  most  often  due  to  diseases  of 

•The  term   "papillitis"    is  now   used   for    "optic 
neuritis,"  "swollen  disk,"  "  •hoked  disk,"  &c. 


the  brain  and  spinal  cord,  as  locomotor  ataxy, 
lateral,  and  insular  sclerosis,  and  hydrocephalus, 
(be. 

It  is  almo-st  beyond  peradventure,  that  alcohol 
and  tobacco,  singly  or  combined,  used  in  excess 
for  a  length  of  time,  will  induce  congestion  or 
a  low  grade  of  inflammation  of  the  optic  nerve 
with  secondary  atrophy,  and  more  or  less  marked 
amblyopia.     (Abstinence  and  strychnia,   with 
or  without   electricity,  generally   issue  in    re- 
covery.)    Lead  poisoning  may  also  induce  optic 
neuritis  ending  in  atrophy.   It  is  now  undoubted 
also  that  in  some  subjects  quinine  taken  in  large 
doses  at  short  intervals  will  cause  temporary 
blindness  or  great  imimirment,  and  also  a  perma- 
nent contraction  of  the  field  of  vision.    Though 
the  etiology  of  the  affection  is  obscure,  it  is  well 
known  that  there  is   a  characteristic  (though 
not   pathognomonic   or   constant)    retinitis  in 
morbus    Brightii.       There    is    a   hsemorrhagic 
retinitis  due  to  various  causes,  as  malarial  fever, 
thrombosis,  <fec.,  and   which  may    also  be  the 
precursor  of  similar  but  much  graver  changes  in 
the  cerebral  mass.    Syphilitic  iritis  cannot  easily 
be  overlooked,  but   as  specific  neuritis,  neuro- 
retinitis,    and    retino-choroiditis  may   develop 
insidiously  without  external  symptoms  or  gene- 
ral manifestations,  any  complaints  of  syphilitic 
subjects  as  to  failing  sight  merit  prompt  atten- 
tion.  Neuro-retinitis  may  nlso  occur  in  diabetes, 
leucocythsemia,  progressive  pernicious  anaemia, 
<fec.,  and  in  the  two  latter  is  often  of  hfemorrhagic 
type.     Embolism  of  the  central   artery  of  the 
retina  causes  opacity  of  the  retina  from  oedema 
(or  lymphoid  infiltration),  and  blindness.     Sup- 
purative choroiditis  or  panophthalmitis,  with 
loss   of  the   eve,  may  occur  in  cerebro- spinal 
meningitis,   phlebitis,   low  fevers,   &c.     It   is 
well   known    that    paralysis    of   one   or    more 
of  the  ocular  nerves  with  variable  strabismus 
(and   double   vision)    may    be    due    to   basilar 
meningitis  or  less  serious  central   trouble.       A 
transient  paresis  of  one  or  more  of  the  ocular 
muscles  sometimes  precedes,  even  by  a  t«rm  of 
years,  locomotor  ataxy  and  general  paralysis  of 
the  insane.       Paralysis  of  the  sphincter  iridis 
and  loss  of  accommodation  are  also  sometimes 
premonitory    symptoms.      Dilatation    of    the 
pupil    (mydriasis)    is    found   in  diphtheria,  in- 
sanity,    meningitis,     hydrocephalus,    cerebral 


OF  MEDICAL  SCIENCE. 


189 


tumors,  amaurosis ;  also  in  cases  of  intestinal 
worms.  It  is  a  symptom  of  inflammatory 
glaucoma  and  is  generally  present  in  confirmed 
glaucoma  and  intra-ocular  growths  ;  it  is 
induced  by  blows  upon  the  eye,  and  the  use  of 
certain  agents.* 

Contraction  of  the  pupil  (myosis)  is  due  espec- 
ially to  lesion  of  the  cervical  spinal  cord,  and 
may  be  due  to  meningeal  irritation  or  incipient 
meningitis.  Paralysis  of  the  cervical  sympa- 
thetic also  causes  it  (or  rather  non-dilatability), 
as  well  as  the  act  of  accomodation  and  some 
drugs,  t  Inactivity  of  the  pupil  under  varying 
degrees  of  light  is  often  found  in  locomotor 
ataxy,  with  or  without  myosis,  but  with  con- 
traction during  accommodation.  Contraction 
of  pupil  induced  by  opium  need  not  be  dwelt 
upon. 

OPTICAL    DEFECTS,  ASTHENOPIA,  STRABISMUS. 

In  the  case  of  so  delicate  an  organ  as  the  eye, 
it  is  not  unnatural  to  suppose  that  if  the  sight 
be  good  and  the  eye  apparently  healthy  there 
cannot  be  much  amiss.  As  in  other  instances 
appearances,  are  deceitful,  and  leaving  out  of 
count  at  present  that  vision  may  be  perfect 
and  the  eyes  functionate  well  with  (double) 
optic  neuritis,  an  optical  defect  may  exist  in  an 
organ  the  perfection  of  beauty  ;  and  there  may 
be  weakness,  so-called  insufliciency,  of  one  or 
other  of  the  recti,  though  there  be  no  squint, 
and  the  various  ocular  movements  are  properly 
made. 

The  normal  eye  is  so  constructed  that  dis- 
tant objects  within  its  ken  are  seen  without 
effort,  i.e.,  with  the  eye  (or  ciliary  muscle)  in 
a  passive  state  ;  and  by  what  is  termed  the  ac- 
commodative eflGiJrt,  effected  involuntarily,  viz., 
by  contraction  of  the  ciliary  muscle,  relaxation 
of  the  zonula,  causing  or  allowing  increase  of 
thickness  and  of  focal  power  of  crystalline  lens, 
near  objects  are  also  seen  distinctly,  and  this 
accommodation  can  be  kept  up  for  hours  at  a 

•The  list  of  mydriatics  is  on  the  increase,  daturine, 
hyoscyamine,duboisine,  and  homatropine  hydro-bromate 
being  now  employed,  but  atropine  (atropiae  sulph. )  is 
still  by  far  the  most  generally  available. 

tEserine,  the  principal  ingredient  of  calabar  bean, 
is  a  powerful  myotic,  and  pilocarpine,  [of  jaborandi,  is  a 
valuable  one ;    and   both   reduce    tension,   especially 


stretch  with  the  delightful  unconsciousness  of 
one's  having  eyes.  The  latter  implies  also 
proper  innervation  of  the  internal  recti,  by 
which  the  convergence  of  the  optics  axes  neces- 
sary in  near  work  is  effected,  and  a  certain 
relation  between  the  external  and  internal 
recti,  and  that  there  shall  be  no  disturbing  ex- 
trinsic causes. 

Now,  given  the  typical  eye,  whose  depth,  or 
antero-posterior  axis  is,  say  25  mm.,  and  there 
are  two  principal  departures  from  the  normal 
(standard)  :  in  one  class  the  globe  is  too  shal 
low,  the  axis  too  short — the  far  or  oversighted, 
or  hypermetropic  eye  ;  in  the  second,  the  globe 
is  too  deep,  the  axis  too  long,  the  shortsighted 
or  myopic  eye. 

Since  in  hypermetropia  some  accommodative 
effort  is  required  even  fot  far  vision  and  ordin- 
ary purposes,  the  ciliary  muscle  is  never 
at  rest,  and  there  is  also  an  extra  strain  upon 
it  at  near  work,  conscious  effort  is  ioon  evoked, 
and  more  or  less  discomfort  (which  can  only  be 
relieved  or  prevented  by  the  use  of  convex 
glasses.) 

In  myopia  good  far  vision  can,  of  course,  only 
be  had  by  means  of  concave  glasses,  and  as  the 
eye  in  a  passive  state  is  adapted  for  divergent 
rays,  i.e.,  for  near  work,  accommodation  has,  in 
in  certain  cases,  to  be  suspended  while  con- 
vergence is  kept  up,  a  divorce  of  correlated 
functions  which  is  apt  to  cause  trouble.  There 
is  a  third  kind  of  optical  defect:.,  astigmatism,  in 
which  owing  to  an  abnormal  curve  of  the 
cornea  (or  lens),  different  meridians  of  the  eye 
have  different  refractive  powers,  and  in  some 
instances  so  great  is  this  difference  that  the 
eye  proves  to  be  both  shortsighted  and  long- 
sighted at  the  same  time.  Peculiar  cylindrical 
lenses  are  required,  the  ordinary  spherical  not 
meeting  the  indication. 

Again,  relative  or  absolute  weakness  of  the 
internal  recti  (shown  by  inability  to  fix  both 
eyes  together  upon  an  object  brought  up  close 
in  the  mesial  plane),  renders  prolonged  adduc- 
tion, as  in  reading  or  other  close  work,  irksome 
or  impossible,  especially  if  there  be  general 
debility,  or  uterine  or  ovarian  disease,  hysteria, 
(kc,  which,  in  turn,  induce  also  weakness  or 
disorder  of  the  ciliary  muscle  and  impaired 
accommodation. 


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CANADIAN  JOURNAL 


In  presbyopia,  the  failure  of  the  accomoda- 
tion of  middle  and  old  age,  due  to  physiological 
drying,  hardening  and  inelasticity  of  the  crys- 
talline lens  (not  to  flattening  of  the  cornea),  the 
resort  to  convex  glasses  which  shall  enable  one 
to  read  small  print  at  12  to  15  inches,  is  too 
often  deferred  from  prejudice  until  a  great  deal 
of  unnecessary  discomfort  has  been  felt. 

The  facts  thus  briefly  cited  explain,  in  great 
measure,  the  large  number  of  cases  of  what  is 
styled  asthenopia,  or  weak  sight,  the  prominent 
symptom  of  which  is,  more  or  less  discomfort 
or  sense  of  painful  fatigue  in  and  about  the  eye, 
on  and  after  engaging  at  close  work  (more 
especially) ;  other  signs  or  symptoms  being 
blurring  of  print,  confusion  of  sight,  inability 
to  sustain  the  use  of  the  eyes  at  near  work, 
sensations  of  heat  or  smarting  in  eyes  or  lids ; 
often  also  hypersemia  or  a  slight  chronic  in- 
flammation of  the  edges  of  the  lids  which 
resists  ordinary  remedies  unless  the  cause  is 
removed.  Pain  in  the  region  of  the  eye  felt 
only  on  or  after  taxing  it,  points  to  an  optical 
defect,  or  muscular  weakness.  Frontal  head- 
ache is  not  unfrequently  due  to  one  or  both  of 
these  causes.  Indeed,  the  cephallagia  is  oc- 
casionally of  so  serious  a  nature  as  to  excite 
suspicion  of  cerebral  mischief.  Some  notable 
cases  in  point  were  published  some  years  ago 
by  S.  Weir  Mitchell  (and  many  are  on  record). 
in  which  relief  was  only  had  by  correcting,  by 
proper  glasses,  the  optical  defects  present. 
What  may  be  termed  reflex  asthenopia  is  per- 
haps the  most  annoying  and  often  the  most 
difficult  to  relieve,  in  which  with  too  slight 
optical  defect  or  muscular  weakness,  it  may  be, 
to  account  for  the  symptoms,  there  is  some  ex- 
trinsic cause  at  work,  as  uterine,  ovarian,  pros- 
tatic, <kc.,  trouble,  or  *  neurasthenia,'  or  hysteria 
(which  may  in  some  sense  be  regarded  as  per- 
verted nervous  energy). 

A  few  words  further  on  optical  defects  and 
the  related  subject  of  strabismus : — 

HYPERMETROPIA. 

Hypermetropia  is  quite  common,  and  is  de- 
tected by  the  fact  that,  as  a  rule,  far  vision, 
though  apparently  normal,  is  not  rendered 
worse  by  convex  glasses,  (except  in  cases  re- 
ferred to  below) ;  and  if  defective,  is  decidedly 
improved  or   rendered    normal    thereby.        A 


certain  flatness  of  the  face  is  suggestive  of  it, 
as  also  a  distinct  space  between  the  globe  and 
outer  can  thus. 

When  it  is  of  high  degree  far  vision  may  be 
bad  (simulating  myopia,  it  may  be),  and  if  good 
is  had  at  too  great  a  strain  ;  and  as  the  defect 
is  congenital  as  well  as  hereditary,  many 
young  subjects,  contrary  to  the  general 
opinion,  require  to  wear  convex  glasses  con- 
stantly to  see  distinctly  and  with  comfort; 
sometimes,  indeed,  as  strong  as  those  ordin- 
arily worn  by  persons  set.  70  for  reading,  &c. 
In  lesser  degrees  of  the  defect  the  aid  of  convex 
glasses  is  only  needed  during  close  work ;  and 
when  there  is  some  special  cause  of  enervation, 
as  sickness,  lactation,  worry,  &c.,  they  may 
only  be  required  temporarily. 

In  unrelieved  hypermetropia  there  is  often 
retinal  hypersesthesia,  and  the  ophthalmoscope 
shows  congestion  of  the  optic  nerve  and  retina. 
Sometimes,  also,  spasm  of  the  ciliary  muscle 
ensues,  and  there  is  a  pseudo-shortsightedness, 
concave  glasses  improving  far  vision,  and  yet 
affording  no  relief  or  proving  worse  than  use- 
less. It  is  in  such  cases,  more  especially,  that 
atropine  and  other  agents,  which  paralyze  the 
ciliary  muscle  and  reveal  the  actual  refractive 
condition,*  are  made  use  of  in  repeated  instil- 
lations before  testing  with  lenses,  the  ophthal- 
moscope not  yielding  sufficiently  trustworthy 
results  though  enabling  one  to  gauge  the 
refraction  pretty  closely  in  many  instances. 

It  is  well  known  that  the  ciliary  muscles  and 
the  internal  recti  functionate  together.  Now, 
the  extra  tension  of  the  former,  incidental  to 
the  shallow  or  hypermetropic  eye,  is  almost 
necessarily  accompanied  by  undue  contraction  of 
the  internal  recti;  and  this  is  the  main  element 
in  the  pathogeny  of  convergent  strabismus,  two- 
thirds  of  the  cases  of  which  are  due  to  hyper- 
metropia. Primary  or  congenital  anomalies  in 
the  ocular  muscles  are  also  common  causes  of 
convergent  strabismus,  and  opacities  of  cornea 
or  lens  occasional  ones  ;  but  those  assigned  by 
the  laity  are  often  only  supposititious. 

*  Atropise  Sulph.  gr.  iv.  ad  «j  aq. ;  Duboisise  sulph.  gr. 
ij.  ad  5J  ;  Hyoscyamiai  sulph.  gr.  iv.  ad  ^j  ;  and  Homa- 
tropine  Hydro-bromate  gr.  vj.  ad  ^j,  are  in  use,  and 
have  their  respective  merits,  but  as  yet  the  most  widely 
used  if  not  the  most  reliable  is  the  Atrop.  Sulph. 


of'  MEDICAL  SCIENCE. 


191 


The  periodic  convergent  squint  of  childhood, 
which  is  generally  due  to  hypermetropia,  and 
is  observed  when  the  eyes  are  engaged  on  near 
objects,  can  be  corrected,  and  sometimes  also 
prevented  from  becoming  confirmed,  by  the  use 
of  atropine  to  annul  the  ejQfects  of  the  ciliary 
muscle,  or  by  the  use  of  convex  glasses  to 
correct  the  optical  defect,  or  by  both. 
.  When,  however,  the  squint  is  fully  con- 
firmed, it  is  desirable  to  restore  the  parallel- 
ism of  the  optic  axes,  even  at  an  early  age. 
The  sight  of  a  squinting  eye  is  generally 
quite  defective.  Reasoning  by  analogy  it  is 
natural  to  attribute  this  amblyopia  to  the 
mal-position,  and  though  the  view  is  gaining 
ground  that  squint  is,  rather,  determined 
by  a  congenital  or  precedent  amblyopia, 
the  practice  of  deferring  the  operation  until 
puberty  or  later  should  not  be  followed.  It 
will  be  seen  that  there  is  something  more  in 
the  treatment  of  strabismus  than  the  mere 
tenotomy,  (indeed,  the  latter  may  be  unnec- 
essary, correcting  glasses  sufficing) ;  and  in 
all  cases  the  refractive  condition  should  be 
learned  with  a  view  to  intelligent  treatment. 

MYOPIA. 

It  should  be  borne  in  mind  that  the  ellip- 
soidal shape  of  the  myopic  eye  is  not  due  to 
bulging  or  undue  convexity  of  the  cornea  as  is 
often  supposed,but  to  a  process,  more  or  less  mor- 
bid, of  thinning  and  extension  of  the  posterior 
two-thirds  of  the  sclera.  In  the  very  highest 
degree  the  eye  is  about  S^  mm.  longer,  that 
is,  deeper  than  the  normal,  and  not  uncommonly 
it  is  from  2^  to  4  mm. 

Myopia  may  be  congenital,  is  frequently 
hereditary,  and  is  often  acquired,  (generally 
before  the  age  of  20).  The  latter  fact  cannot 
be  too  widely  known.  The  most  potent  cause 
probably  is  prolonged  or  oft-repeated  straining 
of  the  eye  at  close  work,  especially  in  those  of 
subnormal  vitality,  lax  fibre,  (kc,  excessive 
tension  or  spasm  of  the  ciliary  being  set  up,  and 
finally  permanent  organic  changes  developed. 
The  popular  idea  that  shortsighted  eyes  are 
inherently  strong,  is  fallacious  and  mischievous. 
The  myopic  eye  is  often  a  weak  and  irritable 
one,  prone  to  increase  of  the  defect  and  to  the 
development  of  secondary  changes  in  the  retina, 


choroid,  &c.,  which  imperil  the  sight.  Few 
cases  in  ophthalmic  practice  give  one  more 
anxiety  than  those  of  progressive  myopia,  with 
retlno-choroidal  changes  and  vitreous  opacities 
(sclero-choroiditis)  and  tendency  to  detachment 
of  the  retina,  of  which  it  is  the  largest  factor. 
As  myopia  is  so  common,  and  is  largely  on 
the  increase  in  civilized  countries,  prevailing 
especially  in  cities  and  towns,  and  amongst 
those  at  educational  institutions,  seats  of  learn- 
ing, and  literary  centres,  the  importance  of 
prophylaxis  will  be  apparent ;  too  early  at- 
tendance at  school  should  be  interdicted,  preco- 
city should  be  held  well  in  check ;  schooling 
should  be,  more  than  it  is,  the  instructing  young 
folk  how  to  learn  rather  than  the  gaining  from 
them  a  mass  of  facts  which,  too  often,  have  not 
been  really  taught,  but  largely  acquired  (in 
some  fashion)  during  extra  hours  at  home. 
The  stimulus  to  eye-strain  as  well  as  brain- 
work,  offered  by  the  systems  in  vogue  of  com- 
petition, prize-giving,  promotions,  <fcc.,  should  be 
kept  within  more  healthy  bounds ;  a  ban  should 
be  put  upon  undue  taxing  of  the  eye  in  any 
way,  especially  in  young  subjects ;  and  poor 
light,  bad  and  small  print,  '  cheap  '  books,  and 
badly  planned  desks,  (fee,  should  be  banished 
from  our  school-rooms.  The  early  resort  to 
suitable  correcting  glasses  undoubtedly  tends 
to  prevent  the  progress  of  the  defect,  and  the 
development  of  divergent  squint,  60  per  cent, 
of  which  are  due  to  myopia.  And,  contrary 
to  popular  belief,  it  is  often  more  important  to 
adapt  for  ordinary  wear  such  concave  glasses  as 
enable  the  very  myopic  to  read  or  work  at 
ordinary  distances,  use  both  eyes  together  and 
without  stooping,  than  those  which  would  afibrd 
the  best  far  vision,  but  would  be  too  strong  for 
near  work. 

In  the  case  of  weakness  or  insufficiency  of 
the  internal  recti,  which  generally  occurs  in 
myopia  and  aggravates  the  disability  and  the 
tendency  to  passive  divergence,  and  later,  to  con- 
firmed squint,  electricity  suffices  in  some  in- 
stances to  energize  the  muscles;  but  more 
often  the  glasses  which  correct  the  optical 
defect  are  required,  or  possibly  prisms  have 
also  to  be  worn,  and  occasionally  tenotomy  of 
the  external  recti  resorted  to  in  order  to 
restore  the  balance  of  power,  even  though 
there  be  no  actual  squint.  And,  lastly,  in 
some  instances,  a  course  of  systematic  ocular 
gymnastics  has  to  be  caried  out  with  care  and 
perseverance. 

(To  be  continued.) 


192 


CANADIAN  JOURNAL 


DIPHTHERITIC    CROUP,     TRACH- 
EOTOMY. 

BT  ANGUS  MCKINNON,  M.D.,  GUELPH. 

Case  1.  W.  B.,  aged  3  years.  It  was  noticed 
on  the  22nd  of  June  that  he  had  lost  his  voice 
completely,  though  he  appeared  quite  well  in 
all  other  respects.  On  the  24th  he  had  slight 
fever.  Temp.  100°,  pulse  96,  croupy  cough  and 
some  difficulty  in  breathing. 

On  the  26th  strangulation  seemed  so  im- 
minent that  tracheotomy  was  indicated  as 
affording  the  only  chance  for  the  child.  In 
this  view,  Dr.  Howitt,  who  saw  the  case  with 
me,  fully  concurred,  and  after  putting  the 
patient  under  the  influence  of  chloroform  a 
double  silver  tube  was  put  into  the  trachea. 
As  soon  as  the  trachea  was  opened,  the  violent 
spasm  of  cough  that  always  follows  the  free 
entraoce  of  air,  threw  out  several  pieces  of 
membrane.  He  soon  became  quiet,  and  was 
able  to  take  abundance  of  nourishment,  On 
the  ninth  day  it  was  found  that  the  use  of  the 
tube  could  be  dispensed  with.  By  the 
fifteenth  day,  the  child  was  convalescent, 
though  he  still  had  a  little  hoarse  cough,  and 
could  only  speak  in  a  whisper.  On  the  23rd 
day  the  wound  was  completely  healed,  and  by 
making  a  special  effort  he  could  speak  out  loud. 
He  had  no  cough  remaining.  In  the  case  of 
this  patient,  there  was  very  little  external 
swelling,  and  only  two  small  patches  of  mem- 
brane could  be  seen  in  the  pharynx.  The 
preceding  week  an  older  child  in  the  same 
family  died  strangulated,  having  suffered  a 
few  days  from  the  ordinary  symptoms  of 
croup. 

Case  2.  W.  A.,  aged  6  years.  On  June  28tb 
this  little  patient  was  found  in  high  fever,  the 
two  tonsils,  uvula,  and  the  greater  part  of  the 
pharynx  covered  with  thick  membrane.  He 
also  had  a  croupy  cough,  though  the  respiration 
was  not  at  all  embarassed.  Next  day  the  voice 
was  extinct.  He  had  violent  croupy  cough, 
the  breathing  was  labored,  the  sternum  heaving 
with  each  effort,  the  lips  and  nails  were  blue. 
It  was  decided  to  operate  at  once,  and  with 
the  assistance  of  Drs.  Haskin  and  Cowan, 
tracheotomy  was  performed.  During  the  first 
five    days,  he    coughed   up    through   the   tube 


pieces  of   thick  tough    membrane  occasionally. 
In  this  case  considerable   difficulty  was  expe 
rienced  in  maintaining  easy  respiraUon,   not- 
withstanding   the    frequent    removal   of    the 
inner  tube  and  t^e  most  thorough   cleanliness. 
It  would  appear  that  tough   mucus   collected 
in  the  trachea  just  below  the  end  of  the  tube, — 
though  both  tubes  were  removed,  there  was  no 
relief.     The  difficulty  did  not  come  on  suddenly 
as  if   due  to  spasm.     It  was  first  noticed  that 
the    respiratory   act    was  prolonged,  soon    it 
became   whistling  in  character,  and  finally  the 
the    child    was   almost  asphyxiated.     Having 
removed   the    tubes,  I  passed    down   several 
feathers,  a  camel's  hair  biush,    etc.,  but  though 
cough    was    caused,   his   condition     was  only 
aggravated.     Having  no  better  instrument  at 
hand,  I   used  a   long  hairpin  suitably  curved, 
which  I  passed  through  the  wound,  at  least  an 
inch  further  down  the    trachea  than  the  tube 
extended.     By  this  means    I   fortunately  dis- 
lodged a  large  mass   of  pasty,    mucopurulent 
matter,  and  the  cough  caused  by  the  instrument 
expelled  it  through   the   wound.     Immediate 
relief  followed,  and   after  the   tubes  were  re- 
introduced the  respiration   again  became  easy, 
free,  and  regular.     Several  attacks  of  a  similar 
character   occurred,   but  relief    was   obtained 
each  time  by  persevering  in  like  measures. 

The  membrane  disappeared  from  the  tonsils 
about  the  6th  day.  Taut  not  from  the  uvula  till 
the  9th  day.  About  the  same  time  the  ex- 
ternal swelling  subsided.  On  the  8th  day, 
and  before  the  membrane  had  wholly  disap- 
peared from  the  uvula,  it  was  noticed  that  he 
had  difficulty  in  swallowing,  due  no  doubt  to 
paralysis  of  the  muscles  concerned  in  degluti- 
tion. Much  of  anything  he  tried  to  swallow 
passed  into  the  trachea  and  was  coughed  out 
through  the  wound.  The  pulse  became  irregu- 
lar. He  had  occasional  vomiting.  He  became 
gradually  weaker,  and  died  on  the  15th  day. 
The  use  of  the  tube  was  discontinued  on  the 
9th  day,  and  there  was  no  difficulty  in  breath- 
ing. There  was  no  pneumonia,  and  ouly  slight 
bronchial  catarrh.  Though  this  little  patient 
died  from  exhaustion,  yet  by  saving  him  from 
immediate  strangulation  the  operation  was 
successful.  It  is  well  known  that  death  occurs 
occasionally  in  diphtheria,  even  when  there  is 


OF  MEDICAL  SCIENCE. 


193 


no  laryngeal  complication.  Without  the  oper- 
ation, so  far  as  could  be  judged,  he  could  not 
live  mors  than  a  few  hours.  Relieved  by  it, 
he  gave  promise  of  recovery,  till  about  the 
ninth  day  :  after  that  it  was  evident  that  he 
would  die. 

Case  3.  R  H.,  aged  about  4  years.  On  the 
19th  Oct.  this  boy  had  labored  breathing  and 
stridulous  cough.  On  both  tonsils  small 
patches  of  thin  membrane  could  be  seen.  For 
several  days  previously  he  had  this  cough,  but 
was  playful  and  ate  well.  On  the  21st  the 
cough  became  very  dry,  ringing  ;  the  respiration 
labored,  the  sternum  heaving  with  every  breath, 
at  times  the  dyspnoea  was  urgent.  After  care- 
ful consideration  and  consultation  with  Dr. 
Brock  it  was  decided  that  tracheotomy  could 
not  safely  be  longer  delayed.  As  soon  as  the 
trachea  was  opened  several  pieces  of  tough 
membrane  were  forcibly  coughed  out  of  the 
wound.  Here,  as  in  the  second  case,  great 
difficulty  was  experienced  in  keeping  th© 
trachea  free  and  open.  The  respiration,  after 
continuing  easy  and  free  for  hours,  would 
become  slightly  prolonged,  then  whistling,  and 
soon  the  child  would  almost  strangle.  Re- 
moval of  one  or  both  tubes  gave  no  relief.  The 
only  way  of  relief  was  by  carrying  something 
down  into  the  trachea  beyond  the  tube,  to  dis- 
lodge a  pasty  conci-eticn  that  had  gradually 
collected  there.  When  this  wis  coughed  up 
he  would  breath  freely  again  for  hours.  In 
this  manner  this  little  patient  had  several 
narrow  escapes  from  strangulation  during  the 
first  five  days  after  the  operation,  but  after 
that,  a  free  catarrhal  discharge  occurred,  and 
the  respiration  continued  unembarrassed.  The 
use  of  the  tube  was  discontinued  on  the  8th 
or  9  th  day.  He  could  use  his  voice  from  the 
7th  day.  In  two  weeks  he  was  really  well, 
though  the  wound  was  not  entirely  healed 
until  a  few  days  later. 

In  the  management  of  these  three  cases,  the 
same  treatment  was  carried  out.  The  air  of 
the  apartment  occupied  was  steadily  main- 
tained at  a  temperature  of  about  80° — 85°  and 
kept  moist  by  steam.  The  vapour  from  a  hot 
solution  of  lactic  acid  was  inhaled  at  short 
intervals ;  and  in  the  second  case,  the  solution 
was   freely  applied    to  the  pharyngeal  deposit. 


In  the  first  case,  there  was  absolutely  no 
medication  after  the  operation,  because  the 
struggles  of  the  child  against  taking  medicine 
produced  such  violent  cough,  that  it  was 
thought  advisable  to  leave  it  alone.  In  the 
second  case  a  mixture  containing  iron,  quinine, 
pot.  chlor.,  and  glycerine  was  given  regularly 
till  the  difficulty  in  swallowing  occurred. 
Abundance  ot  nourishment  was  given  at  short 
intervals  to  e  ch  patient,  and  stimulants  to  the 
second  and  third,  but  not  to  the  first  for  the 
same  reason  that  no  medicine  was  given. 


A  CASE  OF  SPINAL  CURVATURE. 

BY   GEORGE    A.    TYE,    M.D.,    CHATHAM. 

This  case  contains  nothing  new,  but  illus- 
trates the  value  of  Sayre's  Plaster  Jaciet.  It 
presents  some  rather  unusual  features,  and  may 
therefore  be  interesting  on  its  own  account. 

E.  A.,  a  farmer,  aged  35,  in  October  last 
began  to  sufier  pain  in  the  region  of  the  hip- 
joint,  extending  at  times  below  the  knee,  and 
most  severe  in  the  calf  of  the  leg.  He  be- 
came unable  to  move  about  without  crutches, 
and  general  health  rapidly  declined.  Three 
physicians,  I  was  informed,  had,  in  succession, 
diagnosed  and  treated  sciatica,  without  any 
relief,  even  temporary.  I  saw  him  first,  March 
27th  last,  and  found  him  emaciated — a  worn, 
cachectic  appearance,  and  afraid  to  move.  The 
pain  in  the  left  leg  very  severe  and  persistent, 
li  inches  less  in  cii'cumference  than  its  fellow. 
When  in  the  erect  position  the  gluteal  muscles 
of  the  painful  side  hung  like  a  bag,  so  that  it 
appeared  like  an  accumulation  of  fluid,  but  no 
fluctuation  was  elicited  by  percussion.  Neither 
pressure  along  the  spinal  column,  nor  the  appli- 
cation of  heat  provoked  pain,  neither  did  it  fol- 
low sudden  downward  pressure  on  the  shoulders. 
When  pressure  was  made  upon  one  shoulder  he 
complained.  The  last  three  dorsal  vertebrae 
seemed  slightly  prominent,  but  this  was  not 
sufficiently  marked  to  be  certain.  From  the 
patient  I  learned  that  he  was  always  most  easy 
when  lying  down,  that  he  could  not  ride  in  a 
buggy  without  great  sufl^ering.  Both  these  cir- 
cumstances pointed  to  the  spine,  and  led  me  to 
believe  that  the  prominence  of  the  dorsal 
vertebrae  was  real ;   and  consequently  that  the 


194 


CANADIAN  JOURNAL 


pain  iu  the  extremity  was  due  to  iujury  to  the 
cord  at  that  point. 

Generous  diet,  malt  liquors,  triple  phos- 
phates, and  hydi'oleine  were  prescribed.  On 
April  4th  he  was  suspended,  and  the  ordinary 
roller  plaster  bandage  rapidly  applied.  Before 
it  had  become  hardened,  syncope  occurred,  al- 
though he  was  only  partially  suspended  ;  he 
was  instantly  placed  on  his  back  on  the  jfioor, 
and  extension  kept  up  by  two  men  from  the 
shoulders  and  hips  until  the  bandage  was  firm. 
In  four  days  all  pain  was  gone,  and  he  aban- 
doned his  crutches  ;  in  a  week  he  rode  in  the 
buggy  with  pleasure.  In  the  beginning  of  the 
present  month  (May)  he  came  to  market  in 
Chatham,  a  distance  of  seven  miles,  in  a  lumber 
waggon,  and  suffers  no  pain  whatever,  and  his 
appearance   evinces  remarkable   improvement. 

The  occurrence  of  syncope  was  an  unpleasant 
circumstance.  I  have  frequently  found  delicate 
persons  and  young  girls  suffer  greatly  during 
suspension,  so  that  I  was  obliged  to  devise 
other  methods  of  extension,  and  a  bandage 
that  can  be  rapidly  applied. 

The  patient  is  placed  in  the  proue  position 
on  a  bench  of  two  sections.  The  one  fixed,  the 
other  movable  by  a  screw  below ;  the  shoulders 
and  hips  are  strapped  to  the  separate  sections, 
and  a  few  turns  of  the  screw  make  slight 
extension,  which,  together  with  the  position 
of  the  patient,  gives  the  spine  a  proper 
direction. 

The  bandage  is  made  by  taking  two  pieces  of 
Canton  flannel  or  cotton  with  their  woolly 
surfaces  in  apposition,  and  then  cutting  them 
so  as  to  exactly  fit  the  body  over  the  close- 
fitting  wool  shirt.  Gored  pieces  are  inserted 
under  the  arms  and  over  the  hips.  The  two 
pieces  are  also  stitched  down  the  centre  in 
two  lines,  leaving  an  interval  of  an  inch  or 
more  over  the  spine,  that  will  admit  no  plaster, 
which  will  be  freely  applied  to  the  opposing 
surfaces,  and  the  free  edges  tacked  together. 
The  prepared  bandage  is  now  moistened  by 
placing  it  in  a  shallow  vessel  with  a  little  water, 
and  when  moistened  is  laid  across  the  back  so 
that  the  portion  between  the  stitching  down 
the  centre  will  be  over  the  spine.  This  is  now 
easily  brought  into  perfect  apposition  by  apply- 
ing a  dry  roller  over  the  whole.     This  bandage 


is  light,  stiff,  and  dries  rapidly,  and  the  patient 
suffers  but  little. 

Surgeons  are  divided  in  opinion  respecting 
the  utility  of  plaster  jackets  in  lateral  curvature 
ot  the  spine ;  some  maintaining  that  develop- 
ment of  the  muscles,  the  natural  supporters,  is 
alone  essential — others  that  artificial  support 
is  required.  Both  have  advantages.  The  spine 
needs  artificial  support  until  the  natural  forces 
are  equal  to  the  task 

The  splint  first  described  with  the  hinge- 
joint  can  be  removed  daily  by  removing  the 
roller.  A  system  massage  and  muscular  exercise, 
can  be  carried  on  every  day,  and  this  well- 
fitting  corset  re-applied.  Three  cases  of  lateral 
curvature  thus  treated  have  been  fairly  success- 
ful. 

Chatham,  May,  1882. 


CASES  IN  PRACTICE. 

BY  J.  FERGUSON,  B.A.,  M.B.,  L.R.C.P.,  ETC., 
Assistant  Demonstrator  of  Anatomy,  Toronto  School  of  Medicine. 

INTERMITTENT    NEURALGIA. 

Under  this  name  I  intend  recording  two 
cases.  I  had  some  doubt  as  to  what  name 
should  be  given  to  them,  and  adopted  the 
above. 

Mr.  Fortune,  aged  55,  called  one  forenoon  to 
see  me.  He  said  that  he  had  suffered  intensely 
with  headaches  for  about  a  year.  He  has 
always  been  a  sober  man,  and  never  lived  in  any 
locality  where  malarial  poison  was  prevalent. 
His  present  trouble  began  simply  as  an  in- 
ability for  application  to  his  work  as  a  carpen- 
ter. He  has  a  good  deal  of  drawing  and  calcu- 
lating to  perform,  and  for  this  he  now  finds 
himself  totally  unfit.  His  mind  is  so  weakened 
that  the  least  mental  effort  is  too  great  for 
him.  He  has  scarcely  resolution  enough  to 
take  his  medicine. 

When  in  my  oflice  one  of  his  headaches  came 
on.  It  was  violent  indeed.  He  moaned 
deeply,  his  brows  were  firmly  knit,  and  he 
trembled  from  head  to  foot.  The  attack  lasted 
about  half  an  hour.  I  gathered  from  the 
patient  that  these  attacks  came  on  from  two  to 
three  times  a  day,  and  would  often  seize  him 
in  the  midst  of  a  meal,  or  when  out  on  the 
street. 


OF  MEDICAL  SCIENCE. 


195 


Quinine  in  pretty  large  doses  w&i  ordered, 
but  did  not  give  very  good  results.  Lately  the 
patient  has  been  in  the  habit  of  taking  chloral 
to  procure  sleep ;  but  gave  this  up  at  my  sug- 
gestion. Afterwards  quinine  in  small,  frequent 
doses  was  given  in  the  following  manner  :  The 
fingertip  is  to  be  pressed  against  the  dry  powder, 
and  the  amount  thus  lifted  to  be  taken  every 
ten  minutes  or  so.  When  used  in  this  way  it 
seemed  to  accomplish  much  more  than  when 
given  in  larger  doses  at  longer  intervals. 

The  other  case  was  one  that  was  treated  at 
the  out-department  of  the  Royal  Infirmary  of 
Glasgow,  in  October,  1880.  The  general  his- 
tory was  very  much  the  same  as  that  just  given. 
He  was  ordered  syr.  ferri  phosphatis  c.  quinia 
et  strychnia.  How  the  patient  did  I  cannot 
say,  as  he  passed  from  my  notice  shortly  after- 
wards. In  my  own  case  there  were  no  apparent 
curative  results,  though  the  symptoms  were 
greatly  relieved  by  the  quinine. 

The  feature  of  importance  in  these  cases  is, 
that  from  some  detiiled  accounts  given  by 
British,  French,  and  German  observers,  they 
almost  invariably  end  in  cerebral  paralysis ;  and 
that  these  violent  attacks  of  headache,  occurring 
frequently  and  suddenly,  and  lasting  for  a 
short  time,  while  at  the  same  time  no  definite 
cause  can  be  found,  are  very  suspicious  omens 
of  the  serious  disease  first  named. 

Postmortems  performed  upon  persons  so 
affected,  and  who  may  die  from  accident  or 
some  inter-current  disease,  would  likely  throw 
much  light  upon  this  interesting  condition  ;  and 
one  which,  perhaps,  is  not  very  uncommon  if  a 
general  concensus  of  medical  opinion  could  be 
obtained. 

ACNE   VULGARIS. 

It  is  well  known  that  this  is  anything  but  an 
easy  trouble  to  deal  with.  Recently  I  have 
had  three  well  marked  cises  under  treatment. 
In  one  of  which  the  amount  of  suppuration 
was  very  great ;  and  the  entire  neck  burrowed 
in  all  directions  beneath  the  skin.  These  cases 
were  treated  locally,  by  lancing  regularly  all 
the  acnous,  swellings,  and  using  hot  fomenta- 
tions to  promote  bleeding.  Internally  calcium 
sulphide  was  given  in  gr.  ss.  doses  four  times  a 
day.  The  part  of  the  treatment  that  ap- 
peared of  decidedly  most  value  was  the  thorough 


application  of  iodoform.  It  was  ordered  as  an 
ointment.  lodoformi,  jii ;  vaselinae,  ^j.  to  ^^ 
rubbed  in  thoroughly  night  and  morning,  after 
using  the  hot  fomentation.  The  effects  of 
the  iodoform  in  the  above  cases  was  very 
pleasing.  Iodoform  thus  applied  to  the  skin 
unites  with  the  fat,  and  free  iodine  is  produced. 
Ti  is  in  turn  unites  with  the  albumen,  and  is 
thus  absorbed.  In  this  way  it  has  certainly 
a  local  alterative  action.  The  albuminate  of 
iodine  is  also  forme  .  when  an  oily  solution  ia 
injected  under  the  skin. 


A  CASE  OF  (SO-CALLED)  TROPICAL 
ABSCESS  OF  LIVER. 

Under  the  care  of  Drs.  W.T.  Aikins  and  H.  H.  Wright,  Lecturers 
respectively  on  Surgery  and  Medicine  in  the  Toronto  School. 

Mr.  B.,  set.  49,  weighed  in  health  207  lbs.; 
height  5  feet  8f  inches.  Had  always  enjoyed 
good  health  except  for  3  weeks  in  1879,  when 
he  had  an  attack  of  jaundice,  accompanied  with 
symptoms  of  gall-stone.  Sometime  in  the  fall 
of  1881  it  was  noticed  (about  October)  that  he 
had  a  cough,  accompanied  with  bronchial 
expectoration,  and  a  sense  of  pain  without 
tenderness,  especially  on  deep  inspiration  and 
forced  expiration,  in  the  pit  of  the 
stomach.  In  the  latter  part  of  October  he  had 
night  sweats  ;  but  there  had  been  no  chill,  nor 
noticeable  heat  of  skin.  He  continued  to 
attend  to  business  until  about  the  middle  of 
December  when  increasing  weakness  compelled 
him  to  remain  at  home.  By  this  time  his 
appetite  was  poor  and  he  had  lost  flesh.  He 
then  took  to  bed,  and  jaundice  of  3  weeks 
duration,  giving  the  icteric  tint  of  skin  and 
urine,  occurred.  By  the  10  th  of  January  he 
was  complaining  of  severe  pain  to  the  left  of 
the  umbilicus,  and  the  abdomen  in  this  situa- 
tion was  found  to  be  swollen  and  tender.  The 
night  sweats  had  increased.  During  all  this 
time  there  had  been  no  gastric  symptoms 
except  the  anorexia ;  but  the  bowels  were  con- 
stantly confined.  The  cough  and  expector- 
ation were  no  longer  present,  but  he  continued 
to  lose  flesh.  The  emaciation,  pain  and  swell- 
ing continuing,  the  advice  of  Drs.  W.  T. 
Aikins  and  H.  H.  Wright  was  sought.  They 
found  him  pale  and  anaemic  with  anorexia  and 


196 


CANADIAN  JOURNAL 


emaciation.  Eespirations  24,  occasional,  rare 
but  not  troublesome  cough.  On  inspection 
the  left  side  of  the  abdomen  was  round,  full, 
and  prominent ;  the  respirations  mainly  thor- 
acic ;  on  palpation,  the  left  lobe  of  liver  was 
found  to  extend  from  the  right  of  the  mesial 
line  downwards  to  Poupart's  ligament,  and  to 
the  left  to  within  a  finger's  breadth  of  the 
anterior  superior  iliac  spine.  It  was  firm, 
smooth,  and  free  from  tenderness  except  at  one 
point  which  was  an  inch  and  a  half  or  two 
inches  to  the  left  of  the  umbilicus.  Here  for 
the  space  of  an  inch  in  diameter  fluctuation 
could  be  detected.  At  a  subsequent  examina- 
tion 4  days  later,  in  the  presence  of  1  rs.  Canniflf 
and  May,  the  temperature  was,  in  the  after- 
noon, 102^;  pidse,  112;  respiration  acceler- 
ated. Patient  was  entirely  free  of  jaundice 
and  gastric  symptoms.  The  most  prominent 
part  of  the  swelling  was  now  tympanitic,  thin, 
and  evidently  pointing.  Aspiration  was 
accordingly  performed  under  the  carbolic  spray, 
and  from  10  to  12  ounces  of  extremely  foedd, 
thick  and  greyish  pus  were  withdrawn,  pre- 
ceded by  a  quantity  of  foetid  gas.  This 
afforded  marked  relief  to  the  breathing,  and 
occasioned  no  inconvenience  whatever.  The  sac 
was  subsequently  washed  out  with  carbolic  solu- 
tion, and  this  was  repeated  daily.  The  appe- 
tite began  to  improve,  and  the  hectic  symptoms 
to  diminish  ;  but  in  the  course' of  10  days  a 
cessation  of  improvement  was  observed,  and  it 
was  found  that  another  purulent  collection  wag 
taking  place  a  little  below  the  point  of  the 
xiphoid  appendix  on  the  left  side.  This  was 
evacuated,  and  improvement  again  set  in  with 
the  daily  injections.  The  left  lobe  of  the  liver 
constantly  diminished  in  size,  but  a  small 
amount  of  suppuration  in  two  or  three  differ- 
ent places  temporarily  interrupted  the  course 
of  amelioration,  which  was,  however,  always 
resumed  on  the  evacuation  of  the  matter. 
Since  the  first  aspiration  there  has  been  a 
regular  daily  discharge  of  about  a  drachm  of 
matter  which  still  continues  up  to  the  119th 
day,  the  time  of  writing.  Patient  has  never 
been  subjected  to  any  tropical  influence  what- 
ever, but  has  always  been  a  pretty  free  liver. 


The  70th  birthday  of  Von  Arlt,  the  Vienna 
Ophthalmologist,  was  celebrated  on  April  18th. 


DISLOCATION    OF    HUMERUS.     RE- 
DUCTION AFTER  TWO  MONTHS. 

BY  S.  COWAN,  M.D.  TOR.,  HARRISTON. 

Your  reference  to  the  suit  for  malpractice 
against  Dr.  Wm.  Brock,  of  Bismarck,  recalls 
to  my  mind  a  case  in  my  own  practice, 
in  the  early  part  of  1876,  which  has  not  been 
hitherto  reported. 

Mr.  D.  came  into  my  ofl&ce,  just  aV)Out  the 
twilight,  with  his  arm  in  a  sling.  Without 
rising  from  the  lounge  where  I  had  happened 
to  be  lying,  I  placed  my  hand  on  his  shoulder, 
on  his  uncovering  it.  I  at  once  remarked,  with 
surprise,  that  his  shoulder  was  dislocated  (1 
mention  this  in  this  way  to  show  how  dis- 
tinctly marked  the  dislocation  was).  It  was 
an  anterior  dislocation,  the  head  of  the  hu- 
merus being  under  the  coracoid  process. 

As  Mr.  D.  and  family  had  previously  been 
my  patients,  I  supposed  he  had  just  met  with 
the  accident,  there  being  no  swelling  of  the 
part.  He  stated,  in  answer  to  my  enquiry, 
that  he  had  fallen  from  the  railway  platform. 
On  my  enquiry  as  to  how  long  since  (supposing 
it  to  have  been  only  a  few  minutes),  he  sur- 
prised me  by  stating  it  happened  two  months 
ago.  He  had  applied  to  Dr.  G.,  who  stated  it 
was  only  a  hurt,  and  gave  him  lotions  to  allay 
swelling,  &c.  When  I  learned  that  Dr.  G.  had 
been  treating  the  case,  I  requested  Mr.  D.  to 
get  Dr.  G.  and  we  would  try  and  replace  it,  and 
say  nothing  more  about  it,  as  we  are  all  liable 
to  make  mistakes.  Mr.  D.  at  once  went  to 
Dr.  G.  's  office,  but,  as  I  think  very  unreason- 
ably and  very  foolishly,  the  Dr.  refused  to 
come  to  my  office,  saying  he  would  go  to  Mr. 
D.'s  house.  Mr.  D.'s  friend,  who  came  with 
him,  as  well  as  myself,  declined  to  to  do  this 
as  I  thought  I  had  done  enough  when  I  sent 
for  Dr.  G.  to  assist  me. 

After  a  short  attempt  (with  the  aid  of  some 
neighbours)  at  reduction.  I  decided  to  wait 
for  Dr.  Clarke,  of  Guolph  (now  of  Palmerston), 
who  had  appointed  to  be  at  my  office  the  next 
day  on  another  matter.  On  Dr.  Clarke's  advice 
we  decided  to  wait  a  fe  w  days  to  get  pulleys. 

Dr.  Clarke  came  with  these  a  few  days  after- 
wards, and  we  placed  the  patient  on  a  carpen- 
ter's bench  where  the  vices  at  different  points 


OF  MEDICAL  SCIENCE. 


197 


gave  us  good  support  for  extension  and  counter 
extension.  Dr.  Clarke  gave  the  chloroform, 
and,  aided  by  his  advice,  I  attended  to  the 
shoulder,  while  Dr.  Crandell,  of  Clifford,  di- 
rected the  men  (four  in  number)  at  the  pulleys. 
The  extension  was  kept  up  until  the  men 
stated  they  could  hardly  draw  a  pound  more, 
and  at  the  end  of  about  twenty  minutes  or  half 
an  hour  we  had  the  satisfaction  of  seeing  the 
head  of  the  humerus  clear  of  the  coracoid  pro- 
cess, and  by  drawing  it  firmly  into  the  glenoid 
cavity,  and  holding  it  there  (while  the  men  at 
the  rope  pulley  relaxed  slowly)  and  pushing  the 
arm  across  the  chest  we  succeeded  in  com- 
pletely replacing  the  whole,  and  alter  careful 
bandaging,  the  patient  was  soon  able  to  walk  to 
his  own  house.  During  the  night  some  disar- 
rangement of  the  bandage  took  place,  and  the 
head  of  the  humerus  was  a  little  displaced.  I 
was  able,  however,  without  assistance,  to  make 
it  all  right  again,  and  it  went  on  well  without 
further  trouble,  and  in  less  than  three  months 
the  man  was  at  work  again,  piling  lumber,  and 
other  heavy  work  without  inconvenience. 

I  do  not  write  for  the  purpose  of  criticising 
any  one,  but  in  Dr.  Brock's  case  I  think  it 
was  a  pity,  both  for  the  Dr.  and  for  his  patient, 
that  a  more  determined  effort,  or  at  least,  some 
effort  had  not  been  made  by  the  two  local  Drs. 
to  reduce  the  dislocation,  seeing  they  recognized 
it^v«  weeks  after  its  occurrence.  In  Mr.  D.'s 
case  it  was  nearly,  it  not  quite,  nine  weeks  after 
dislocation  when  reduction  was  effected,  so  that 
a  more  determined  efiort  than  was  made,  even 
at  the  London  hospital,  migbt  have  been  suc- 
cessful. 

Mr.  D.  did  not  ask  for  damages,  much  less 
threaten  suit,  against  Dr.  G. 


Mtttit^m:  pididtu. 


SCHAEFER   ON   A  MORE   ACTIVE 
FORM  OF  ERGOT. 

Dr.  S.  Schaefer  (Berl  Klin.  Woch.,  No.  21, 
1881  ;  Der  Prakt.  Arzt.,  No.  1,  1882),  having 
abundant  opportunity  of  observing  the   well- 
known  fact  that  the  preparations  of  ergot  at 
present  in  use   are    very  prone  to   lose  their 
activity  after  being  kept  for  a  short  time,  has 
arrived  at  the  conclusion  that  the  uncertainty 
in  the  action  of  the  drug  depends  directly  upon 
the  longer  or  shorter  period  of  time  which  may 
have   elapsed   since    the   crushing   of  the   in- 
dividual    corns,  and  that  a  certain   result  can 
only    be   expected   from   ergot    recently   pul- 
verised.    To  this  end  he  has  for  many  years 
forbidden  the  storage  of  powdered  ergot  in  the 
"  Apotheke  "  which  he  employs,  insisting  upon 
the  corn  being  fresh   ground   in  a  mill  in  the 
presence    of  his   messenger.     This  precaution 
(not  demanded  in  the  German  FharmacopcBia) 
has  had  the  result  of  obtaining  for  the  druggist 
a  local  reputation  for  the  excellence  of  his  ergot 
amongst   surrounding   practitioners.     The   ex- 
planation is  found  by  Dr.  Schaefer  in  the  pro- 
tective  action  of  the  horny    covering   of  the 
corns,     which    by    completely    excluding    air 
from     the   central    parts,  prevents   the   rapid 
change    in   the   sclerotinic   acid,    etc.,    which 
follows  exposure  to  the  atmosphere  even  for  a 
short  period,  by  which  so  much  of  the  activity 
of  the  drug  is  lost.     He  believes  that,  by  the 
universal   adoption   of   this   precaution,   ergot 
would  rapidly  retrieve  its  tottering  reputation. 
— London  Medical  Record. 


Pro.  AUeyne  Nicholson  has  been  appointed 
to  the  chair  of  Natural  History  in  the  Univer- 
sity of  Aberdeen.  Since  holding  a  similar 
appointment  in  our  Provincial  University  he 
has  occupied  the  chair  of  Natural  History  in 
Newcastle  and  in  St.  Andrews.  He  succeeded 
Dr.  Carpenter  as  Swiney  Lecturer  in  Geology 
in  London,  and  took  the  lectures  in  Zoology 
in  Edinburgh  during  the  illness  of  the  late 
Sir  Wyville  Thomson. 


Stchegloff  on  Faradisation  of  the 
Spleen  in  Intermittent  Fever. — The  author 
{Trans,  os  the  Caitcasian  Med.  Soc,  1881,  No. 
3)  relates  a  case  in  which  six  faradaic  appli- 
cations of  twenty  minutes  long  each,  at  in- 
tervals of  three  days,  produced  diminution  of 
the  splenic  tumour,  as  well  as  rapid  im- 
provement of  general  nutrition  of  the  patient. 
As  the  fever  never  reappeared.  Dr.  Stchegloff 
concludes  that  the  cure  was  radical.  [A  re- 
port  of  forty-two  cases  of  intermittent  fever, 
successfully  faradJsed  by  Dr.  Schroeder  of  St. 
Petersburg,  may  be  found  in  the  London 
Medical  Record,  October  1880,  p.  409.1— 
London  Medical  Record. 


198 


CANADIAN  JOCTRNAL 


TKAUMATIC   TETANUS    AND    DEATH 
FROM  VACCINATION. 

Dr.  Bates,  of  Columbia,  reported  a  case  of 
tetanus  from  vaccination,  at  the  meeting  of  the 
South  Carolina  Medical  Association  {Medical 
^etvs).  Ben.  Jones,  a  mulatto,  was  vaccinated, 
Feb.  9th,  on  the  arm,  with  carefully  selected 
humanized  virus.  He  was  again  seen  March 
8th,  when  he  had  ordinary  symptoms  of  tetanus. 
Was  examined  next  day  by  Drs.  Talley  and 
Howe.  A  most  careful  inquiry  into  the 
history  of  the  case,  and  a  searching  examination 
of  the  body,  revealed  nothing  to  cause  it,  except 
a  small  healthy-looking,  painless  ulcer  at  the 
spot  where  vaccination  had  been  performed  a 
month  before.  The  disease  advanced  and 
caused  death  in  fifteen  days,  in  spite  of  careful 
treatment. 


Albertis  on  the  Difference  between 
Diphtheritic  and  Inflammatory  False 
Membranes. — Dr.  Albertis  ( Bollet.  delle 
Scienze  Mediche,  July  1881  ;  Gaz.  Med.  de 
Paris,  Nov.  5,  1881),  by  treating  non-diph- 
theritic false  membrane  with  sulphuric  acid, 
has  obtained  crystals  which  are  insoluble  in 
ether  and  absolute  alcohol,  but  soluble  in 
alkalis,  and  which  he  considers  to  be  crystals 
of  tyrosine.  He  has  not  obtained  these 
crystals  when  subjecting  diphtheritic  mem- 
branes to  the  same  treatment.  He  draws  the 
following  conclusions.  Diphtheritic  false  mem- 
branes have  a  different  chemical  composition 
from  that  of  inflammatory  false  membranes. 
Diphtheritic  membranes  do  not  contain  aromatic 
constituents  like  tyrosine.  The  action  exerted 
by  sulphuric  acid  and  microscopical  examination 
suffice,  therefore,  he  maintains,  to  establish 
the  nature  of  a  false  membrane. — London 
Medical  Record. 


Dr.  Weiss  reports  a  case  of  tabes  dorsalis 
where  stretching  both  sciatic  nerves  was  fol- 
lowed by  good  efi'ects.  The  operation  was  per- 
formed on  the  2nd  of  August  and  on  the  22nd 
of  October  ;  sensation  both  in  upper  and  lower 
extremities  was  normal,  and  the  patient  could 
walk  a  little  without  a  stick. —  Wien.  Med. 
Woch, 


The  Genu- Pectoral  Position  in  Flatulent 
Colic. — Fresh  testimony  as  to  the  value  of  this 
position  was  afforded  at  a  recent  meeting  of  the 
New  York  Obstetrical  Society,  when  Dr.  T. 
G.  Thomas  is  reported  to  have  said  (N^.  Y.  Med. 
Journal),  that  for  a  number  of  years  he  had 
placed  patients  in  the  knee-chest  position  for 
the  relief  of  flatulent  colic,  and  the  efficacy  of 
the  methed  was  somewhat  remarkable.  The 
intestines  fell  forward  and  gas  began  to  escape 
almost  immediately,  giving  the  patient  as  great 
relief  from  her  sufferings  as  if  opium  had  been 
administered  freely.  He  considered  the  point 
of  sufficient  importance  to  justify  him  in  asking 
*^or  the  experience  of  the  members  of  the  Society 
with  regard  to  it.  Dr.  Emmet  said  he  had  em- 
ployed the  method,  and  had  found  it  very 
useful. 

■  -^m* 

Suggestions  Regarding  Hypodermic  In- 
jections.— Dr.  C.  Mason,  of  Peekskill,  N.Y., 
suggests  to  those  who  use  the  hypodermic 
syringe,  that  when  the  packing  on  the  piston 
becomes  worn  and  loose,  and  will  not  readily 
work,  to  remove  the  small  nut  at  the  end  of 
the  piston,  take  half  of  the  packing  ofi"  (it  is 
usually  in  two  parts),  and- place  between  them 
a  piece  of  chamois-skin.  Cut  it  round,  leaving 
it  somewhat  larger  than  the  packing.  He  says  : 
"  It  will  absorb  water,  swell,  and  completely  fill 
the  barrel  of  the  syringe.  A  trial  of  this  will 
convince  the  most  sceptical  of  its  value  over  all 
devices  to  do  away  with  the  most  annoying 
features  connected  with  the  use  of  the  hypo- 
dermic syringe." — Quarterly  Epitome, 
.  *  ♦  fci » 

Gelskmium  an  Antipruritic. — Dr.  Bulkley 
has  directed  attention  to  a  very  important 
point  which  is  often  a  source  of  great  anxiety 
to  the  practitioner,  viz  :  the  difiiculty  in  re- 
lieving persistent  and  wearying  itching  in  skin 
afi'ections.  He  points  out  the  drugs  we  cer- 
tainly rely  on,  viz :  opium,  morphia,  chloral, 
bromide  of  potassium,  aconite,  and  carbolic 
acid,  when  administered  internally,  often  fail  to 
stop  the  unconscious  scratching,  and  he  was 
led  from  the  known  efi'ects  of  gelsemiutm  to  try 
that  drug.  In  certain  cases  he  has  found  it 
decidedly  efficacious.  He  begins  with  ten  drops 
of  the  tincture,  and,  if  in  half  an  hour  there  is 
no  relief,  he  gives  twelve  or  fifteen  drops,  and 
so,  until  one  or  two  drachms  have  been  reached 
in  two  hours. — Quarterly  Epitome. 


OF  MEDICAL  SCIENCE. 


199 


3nvpv^, 


CHARCOT     ON     SANGUINEOUS     DE- 
POSITS   IN    THE    FOLD  OF    THE 
ELBOW. 

Having  had  the  opportunity  of  noting  five 
cases  of  sanguineous  effusion  in  the  region  of 
the  elbow,  and  having  each  time  seen  the 
hsematoma  succeeded  by  a  tumour  of  a  cartila- 
ginous consistence,  M.  Charcot  (Hev.  de  Chir.) 
has  embodied  the  results  in  an  interesting 
memoir.     His  conclusions  are  as  follow  : — 

1.  Violence  which  directly  affects  the  elbow, 
such  as  contusion,  dislocation,  etc.,  or  in- 
directly (as  sprains  and  diastasis),  often 
produce  considerable  effusion  of  blood  through- 
out the  whole  extent  of  the  upper  limb,  and 
especially  at  the  fold  of  the  elbow. 

2.  The  sanguineous  extravasations  seem  to 
have  their  source  in  the  rupture  of  the  vessels 
around  the  joint,  and  especially  in  the  tearing 
of  the  brachialis  anticus  muscle. 

3.  The  effused  blood  is  not  always  com- 
pletely absorbed,  and  is  transformed  into 
fibrinous  clots  situated  at  the  anterior  internal 
side  of  the  fold  of  tjie  elbow  in  front  of  the 
articulation,  and  in  the  substance  of  the  bra- 
chialis anticus. 

4.  The  tumour  thus  found  is  as  large  as  an 
egg,  uneven,  and  of  cartilaginous,  and  even 
bonj,  hardness.  At  the  commencement  it  is 
independent  of  the  bone;  but  subsequently 
may  become  united  to  the  humerus. 

5.  The  sanguineous  deposits  may  interfere 
with  the  movements  of  the  joint,  and  con- 
siderably limit  flexion. 

6.  They  generally  remain  stationary  for  a 
long  time,  and  are  but  little  influenced  by 
ordinary  ti-eatment. 

7.  They  may  give  rise  to  errors  in  diagnosis, 
and  may  be  taken  for  exostoses  of  the  humerus, 
displacement  of  the  coronoid  process,  etc. — 
London  Medical  Record. 


In  the  Independent  Practitioner,  for  March, 
1882,  Dr.  F.  N.  Otis  reports  eight  cases  of 
syphilis  occurring  in  physicians,  originating 
in  infection  of  the  finger  in  vaginal  examina- 
tions.— American  Medical  Weekly. 


Thk  Abortive  Treatment  of  Buboes  with 
Carbolic  Acid. — Dr.  Morse  K.  Taylor,  U.  S. 
Army,  in  the  April  number  of  the  American 
Journal  of  the  Medical  Sciences,  publishes  a 
paper  on  the  abortive  treatment  of  buboes  by 
injections  of  carbolic  acid. 

He  reports  twenty  cases  in  which  he 
certainly  obtained  remarkably  successful  re- 
sults, and  he  states  that  within  the  last  seven 
years  he  has  treated  nearly  one  hundred  and 
fifty  cases  of  various  forms  of  lymphadenitis, 
arising  from  specific  and  non-specific  causes ; 
and,  where  he  saw  the  cases  before  the 
formation  of  pus  was  well  established,  he  had 
not  failed  to  arrest  the  process  immediately, 
and  allay  the  pain  in  a  few  minutes.  His 
method  is  to  inject  from  ten  to  forty  minims  of 
a  solution,  containing  eight  or  ten  grains  to  the 
ounce,  directly  into  the  interior  of  the  inflamed 

gland. — Am.  Med.    Weekly. 

.i«»».. 

Whitehead  on  the   Surgical  Treatment 

OF  Hjsmorrhoids. — Mr.    Walter   Whitehead, 

in  the   Brit.    Med.  Jour.,  Feb.   1882,  p.   148, 

describes  the  method  in  which  he  performs  this 

operation,  and   which,    from   its   novelty   and 

practical    value,    deserves    careful     attention. 

After  the  patient  has  been  carefully  prepared 

for  the  operation,  he  is  placed  under  chloroform 

in  the  lithotomy  position,  and  the  sphincter 

ani  is  paralysed  by   forcible  dilatation   by  the 

aid   of  the  two   thumbs.     A  sponge   is  then 

passed   six   inches   up,  to  prevent   any   fsecal 

discharges    from     coming    down    during    the 

operations.     The   haemorrhoids   are  then  fully 

exposed  and    carefully    dissected  upwards    to 

cheir  highest  limits,  as  much  healthy  mucous 

membrane  being  preserved   as  possible.     The 

hsemorrhoidal  vessel  is  thus  left  simply  attached 

by    loose  cellular    tissue,    and,    being   firmly 

grasped   by    ring-forceps,  is    twisted  until    it 

separates.     The    mucous    membrane    i.s    then 

stitched  to  the  denuded  surface  at  the  verge 

of  the  anus,  and  so  the  open  wound  is  closed 

and  heals  by  first   intention. — London  Medical 

Record. 


Petersen  on  the  Treatment  of  Suppu- 
rating Buboes. — Dr.  O.  Petersen  discusses 
the  various  methods  of  treating  buboes  [St. 
Petersburg   Med.    Wock,  No.  52.,   1881),   and 


200 


CANADIAN  JOURNAL 


describes  the  plau  now  adopted  by  himself. 
He  recommends  that  every  inflamed  bubo 
should  be  painted  with  iodoform-collodion  and 
covered  with  a  warm  compress;  and  this,  he 
states,  is  often  successful  in  dispersing  the 
Bvelling.  If,  however,  suppuration  take  place, 
an  incision  is  made,  and  the  abscess-cavity 
scraped  with  the  sharp  spoon,  after  which  it  is 
washed  out  with  a  20  per  cent,  solution  of 
carbolic  acid.  The  wound  is  then  covered  with 
several  layers  of  salicylic  wool,  and  over  this  a 
firm  pad  of  tow  covered  with  varnished  paper. 
A  bandage  is  then  firmly  and  evenly  applied, 
paste  being  also  sometimes  used  to  give  greater 
firmness,  so  that  the  abscess-walls  are  kept  in 
close  and  accurate  apposition.  In  twenty  cases 
treated  by  the  author  in  this  way,  cure  was 
usually  obtained  after  one  to  three  dressings, 
each  being  left  undisturbed  ten  to  fifteen  days 
on  an  average.  In  one  case,  when  the  pressure 
had  not  been  quite  equable,  a  second  small 
abscess  had  to  be  opened. 


Pidwif^rjl. 


Earache. — In  the  American  Medical  Asso- 
ciation, Dr.  Jacobi  remarked  that  closing  the 
mouth  of  infants  and  children,  and  simply 
blowing  into  the  nose,  is  often  a  very  valuable 
method  of  relieving  severe  earache,  and  that  in 
a  number  of  cases  he  had  obtained  most  ex- 
cellent results  from  this  procedure,  the  cause  of 
the  trouble  probably  being  a  catarrhal  affection 
of  the  Eustachian  tube. — Quarterly  Epitome. 


CHomifiiironflrnfie. 


LWBIMOFF    ON    A    CaSE    OF    InTRAFCETATION. 

— At  a  meeting  of  the  Kazan  Medical  Society 
(Vratch.  Vedomosti,  No.  1,  1882),  Dr. 
Lubimoff  showed  a  very  interesting  case  of 
fcBtus  in  foetu.  In  a  female  child,  born  alive 
at  full  term,  there  was  found  a  subcutaneous 
perineal  tumour,  the  right  half  of  which  was 
dense  and  the  left  soft.  On  post-mortem  ex- 
amination, the  author  discovered  that  the  left 
half  of  the  tumour  contained  two  cysts ;  the 
right  enclosed  various  parts  of  another  foetus, 
namely,  a  fully  developed  foot  with  six  toes,  a 
rudimentary  upper  extremity,  and  a  stomach. 
Between  two  divisions  of  this  tumour  were 
found  two  small  dermoid  cysts,  with  cubic 
epithelial  cells,  striated  muscles,  pieces  of 
cartilage,  and  bones  (with  marrow). — London 
Medical  Record. 


To  the  Editor  of  the  Canadian  Journal  of  Hkdical  Scibnci. 

Sir, — It  may  be  of  some  interest  in  the  dis- 
cu.ssion  now  going  on  about  consulting  with 
Homoeopaths,  to  say  that  Dr.  "Wm.  Clarke,  now 
of  Palmerston,  and  late  President  of  the 
Medical  Council,  held  a  consultation  on  a  purely 
medical  case  (I  believe)  a  few  days  ago,  with 
Dr.  E.  T.  Adams  of  this  town,  a  pure-blooded 
Homoeopath.  And  far  from  concealing  the  fact, 
made  a  rather  ostentatious  display  of  it,  by 
parading  up  and  down  the  main  street  in 
company  with  Dr.  Adams.  I  simply  state  a 
fact  without  comment.  M. 

Harriston,  May  22,  1882. 


To  the  Editor  of  the  Canadian  Journal  or  Mbdical  Sciihcb. 

Sir, — Though  I  am  not  disposed  to  make 
myself  the  champion  of  anyone,  I  like  to  see 
common  fairness  in  all  things  between  man  and 
man.  Your  correspondent,  "  Junius,"  in  stating 
in  the  May  Journal  that  Dr.  Fulton  was  an  ap- 
plicant for  the  position  of  Chairman  of  the 
Provincial  Board  of  Health,  was  entirely 
mistaken.  Dr.  Fulton  was  not  an  applicant 
(though  he  was  urged  by  a  number  of  the 
members  of  the  House  to  become  such),  and 
therefore  any  allusion  by  him  to  the  unfitness 
of  Dr.  Oldright  had  not  their  origin  in  a  feeling 
of  rivalry.  It  is  to  be  hoped  that  you  will  be 
good  enough  to  give  this  correction  space  in 
the  Journal  which,  as  I  am  pleased  to  be  able 
to  bear  witness,  has  usually  manifested  a  desire 
to  give  fair  play  to  all  parties  concerned  in 
a  difference. 

Furthermore,  I  should  like  permission  to 
say  to  your  readers,  through  the  Journal,  that 
the  assertion  in  the  April  numVjer  that  Dr. 
Oldright  had  "  probably  paid  mere  attention  to 
the  subject  "  or  subjects  which  are  to  engage 
the  attention  of  the  Provincial  Board  "  than 
any  man  in  the  Province,''  is,  with  all  due 
respect  to  him,  an  injustice  to  other  members 
of  the  profession.  It  must  be  V)orne  in  mind 
that  "  State  Medicine "  or  public  sanitation, 
including  the  study  of  vital  statistics,  has  a 
much  broader  and  more  comprehensive  meaning 
than  that  too  commonly  associated  with  it,  or 
which  would  confine  it  to  a  system  of  details 


OF  MEDICAL  SCIENCE. 


201 


respecting  sewerage,  ventilation  etc.,  or  even 
to  what  wculd  be  treated  of  in  the  ordinary 
course  of  lectures  on  sanitary  science  as  now 
given.  JusTiTiA. 

[We  are  well  acquainted  with  the  term  in  its 
broadest  significance,  and  quite  prepared  to 
reiterate  the  opinion  we  have  expressed.  — Ed.] 


To  the  Editor  of  the  Canadian  Journal  of  Medical  Scibmcb. 

A  PROYINCIAL  PATHOLOGICAL 
MUSEUM  AND  LIBRARY. 

Dear  Sir, — The  approaching  meeting  of  the 
Ontario  Medical  Association    would   seem  an 
opportune  time  to  discuss  a  subject  which  has 
no  doubt  been  thought  of  by  many  but  seldom 
broached,  namely,  the  establishment  of  a  Pro- 
vincial Pathological  Museum.      Were  nothing 
else  accomplished  than  the  adoption  of  such  a 
scheme,  the  meeting  were  not  held  in  vain  ; 
rather  would  it  be  memorable  for  a  good  work 
begun.      There  is  ample   material  already  to 
make  more  than  the  mere  nucleus  of  a  collec- 
tion which  might  one  day  vie  with  that  of  the 
Royal  College  of  Surgeons.       Not  many  years 
ago  the  major  operations   were  largely  in  the 
hands  of  practitioners  in  our  cities,  but  they 
are,  more  and  more,  being  done  in  town, village, 
and   country  side ;   and    valuable    specimens, 
demonstrating  at  once,  the  physician's  acumen 
or    surgical  skill  and    pathological    problems, 
have  been  increasing  from  year  to  year,  which, 
if  collected  from  far  and  near,  with  epitomized 
histories  accessible,   would  form  in  the  aggre- 
gate a  fitting  monument  to  the  industry  and 
achievments  of  the  profession.       Such  a  collec- 
tion, especially  if  a  library  were  conjoined,  would 
be    ere    long    a    point  of  general    attraction 
because  a  storehouse  of  information,  a  bond  of 
union,  a  source  of  pride  and  pleasure,  of  com- 
mon interest  and  enlarging   benefits    to    the 
whole  profession.  The  records  of  the  Divisional 
and  other  Associations  or  Societies  of  the  past 
few  years  show  clearly  that  "  excelsior  "  is  the 
animus  pervading  our   ranks,  but  much  good 
pathological  mateiial  utilized  it  may  be  for  the 
nonce,   is   being   relegated   to   obscurity    and 
practically  lost.      Until    the   Association  has 
finally  located  the    museum  and   library,  the 
spare   rooms  at  the    official    mansion   of  the 


Council  could  possibly  be  had  for  the  asking,  and 
the  worthy  registrar  secured  as  its  custodian, 
if  not  actual  curator.  The  suggestion  may  also  be 
ventured  that  such  museum  would  be  an  appro- 
priate resting  place  for  the  many  models  and 
varied  appliances,  <kc.,  illustrative  of  hygiene 
in  its  widest  scope,  which  it  is  to  be  hoped 
the  Government,  in  pursuing  the  enlightened 
policy  begun  by  the  establishment  of  a  Pro- 
vincial Board  of  Health,  will  provide  at  no 
distant  day  ;  rather  than  compel  the  country 
to  wait  until  our  worthy  confraternity  shall 
have  a  Parkes  with  ability  and  material  to 
found  another  museum  of  hygiene. 
I  am.  &c., 

R.  A.  Reetk. 
May  22nd,  1882. 

THE  CANADIAN 

lonniiti  of  Ud'ml  hum, 

A  Monthly  Journal  of  Medical  Science,  Criticism, 
and  News. 

To  Correspondents. —  IVe  shall  be  glad  to  re- 
ceive from  our  friends  everywhere,  current  meaical 
news  oj  general  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwarding  reports  of  the  proceedings  of  their 
Associations. 


TORONTO,  JUNE,  1882. 


THE  ONTARIO   MEDICAL  ASSOCIA- 
TION. 

The  Second  Annual  Meeting  of  this  Associa- 
tion will  be  held  in  the  Council  Chamber  of 
the  College  of  Physicians  and  Surgeons  of 
Ontario,  on  Wednesday  and  Thursday,  the  Tth 
and  8th  of  June.  Judging  by  the  interest 
already  manifested  on  various  sides,  by  the 
number  of  communications  promised,  and 
taking  the  very  gratifying  success  of  last  year's 
meeting  as  an  earnest  of  future  vigour  and 
vitality,  '  here  can  be  no  room  for  doubt  as  to 
the  harmonious  and  satisfactory  character  of 
the  gathering  of  1882.  It  is,  however,  a  fair 
subject  for  dubiiation  and  discussion  as  to 
whether  the  present  character  and  mode  of 
conduction  of  such   conventions  tend  in   the 


202 


CANADIAN  JOURNAL 


highest  possible  degree  to  the  promotion  of  the 
interests  and  welfare  of  the  pi'ofession,  or 
whether  certain  modifications  in  their  objects 
and  constitution  might  not  more  fully  realize 
the  good  at  which  they  aim,  and  already  do 
much  to  accomplish.  The  venerable  Dr.  Gross 
is  reported  to  have  said  that  the  last  meeting 
of  the  American  Medical  Association,  at  Rich' 
mond,  Va.,  was  socially  a  success  but  profession- 
ally a  failure  ;  and  we  have  ourselves  repeatedly 
heard  the  same  remark  made  anent  the  meet- 
ings of  the  Canada  Medical  Association.  It 
becomes  us,  therefore,  to  consider  whether  there 
be  not  something  defective  in  the  fabric  which 
accounts  for  the  flaw  we  must  all  deplore. 
Recognising  at  once  the  impossibility  of  an 
eflFect  without  the  pre-existence  of  a  cause,  we 
may  assume,  imprimis,  an  origin  for  the 
deficiency,  and,  to  cut  the  matter  short,  by  the 
suggestion  of  a  possible  remedy  indicate  the 
seeming  insufficiency.  At  such  meetings  many 
papei-s  are  read  which  by  reason  of  abstruseness 
or  inherent  difficulty  of  the  subject  or  length  or 
want  of  impressiveness,  are  not  listened  to  with 
anything  more  than  the  semblance  of  polite 
attention ;  are  not  followed,  and  cannot  be 
intelligently  or  [)rofitably  discussed.  We 
would  therefore  have  these  read  by  title  and 
published  in  th>'  Transactions  of  the  Associa- 
tion, or  in  the  Journals,  where  they  might  be 
leisurely  perused  and  comprehended.  In  their 
place  we  would  have  an  address  by  a  selected 
reader  on  each  of  the  great  divisions  of  Medical 
Practice,  which  addresses  should  constitute  a 
review  of  the  progress  of  the  science  in  its 
various  departments  during  the  preceding  year  ; 
and  the  topics  involved  should  be  opt  n  to  dis- 
cussion by  the  meeting,  when  the  views  and 
experiences  of  members  might  be  reasonably 
expected  and  profitably  adduced.  The  rest  of 
the  time  at  the  disposal  of  the  Association  might 
well  be  occupied  in  tbe  discussion  of  the 
various  topics  of  professional  politics,  in  arriv- 
ing at  an  understanding  of  the  general  profes- 
sional opinion  on  the  burning  question  s  of  the 
day,  in  examining  and  discussing  the  cajes  and 
specimens  presented  to  the  meeting,  and,  more 
particularly,  in  friendly,  social  intercourse,  so 
well  calculated  to  promote  those  sentiments  of 
mutual   respect  and  confraternity,  the  plentiful 


lack  of  which  there  is  still  great  reason  to 
deplore.  This  is  merely  a  general  outline  of 
improvements  which  have  repeatedly  forced 
themselves  upon  our  attention,  and  which  we 
hastily  throw  out  for  what  they  are  worth, 
believing  that  they  will  meet  with  the  concur- 
rence of  many,  we  hope  of  a  majority,  of  our 
readers.  A  list  of  the  papers  to  be  read  at  the 
next  meeting,  of  which  notice  has  been  so  far 
received,  will  be  found  in  another  column. 


ANATOMICAL    SUBJECTS. 

Our  columns  will  be  freely  open  to  a  dis- 
cussion of  the  best  way  and  means  of  in- 
creasing the  facilities  for  procuring  subjects  for 
dissection  in  the  Medical  Schools  of  this  city. 
The  fact  cannot  be  gainsaid,  that  of  the  tripod 
upon  which  the  sure  foundation  of  our  science 
rests,  anatomy  is  the  chief,  the  most  important 
and  necssary  foot.  It  goes  without  saying, 
therefore,  that  a  full  supply  of  anatomical 
material  is  of  paramount  importance  to  the 
embryonic  race  of  medical  practitioners.  In 
this  city,  however,  a  super-abundance  of 
subjects  has  never  been  forthcoming,  notwith- 
standing that  Toronto  may  be  supposed  to  be 
the  chief  centre  of  medical  education  for  the 
Province ;  and  the  reason  seems  to  be,  that 
practically  the  source  of  supply  is  limited  to  the 
unclaimed  decedents  within  the  walls  of  the 
Toronto  General  Hospital.  True,  the  Ana- 
tomy Act  provides  the  Inspector  with  authority 
to  distribute  also  the  unclaimed  bodies  of 
vagrants  found  dead,  and  of  inmates  of  our 
prisons,  among  the  Medical  Schools  and 
registered  teachers  of  anatomy  in  his  district, 
but,  who  ever  hears  of  such  supply  being 
utilized  except  upon  the  rarest  of  occasions  1 
And  why  should  that  same  Act  (Cap.  143,  Rev. 
Stat.  Ont.)  make  an  exception  of  the  unclaimed 
bodies  of  inmates  of  the  Asylums  for  the  In- 
sane, unless  it  be  with  a  view  to  foster  the  in- 
vestigation of  the  anatomical  substratum  of 
insanity  by  reserving  such  material  for  the 
more  learned  scrutiny  of  the  Pathologist  1  If 
this  be  the  reason,  we  can  understand  it,  and  in 
part  approve.  Indeed  we  think  that  in  many 
instances  the  principle  might  with  advantage 
be   applied  to   our  Hospital  unclaimed   dead. 


OF  MEDICAL  SCIENCE. 


203 


for  however  necessaiy  it  may  be  that  students 
should  be  taught  anatomy  in  its  normal  phase, 
we  hold  it  to  be  no  less  important  that  both 
student  and  practitioner  should  be  indoctrinated 
and  informed  in  the  morbid  anatomy  and 
pathological  processes  of  every  case  which  comes 
beneath  their  observation.  As  old  Morgagni 
hath  it,  Nulla  autem  est  alia  pro  certo  noscendi 
via,  etc.  As  the  matter  now  stands,  however, 
post  mortem  examinations  of  Hospital  patients 
have  often  to  be  foregone  in  order  that  the 
subject  may  be  perserved  for  the  use  and 
edification  of  the  schools.  In  order  that  this 
may  be  attained  and  the  other,  perhaps  com- 
mensurate, advantage  not  lost,  we  shall  wel- 
come suggestions  from  our  readers  for  the 
amelioration  of  the  present  condition  of  affairs ; 
and  surely  no  opportunity  can  be  more  fitting 
for  the  effort  than  the  time  in  which  we  are 
called  upon  to  mourn  the  death  of  James 
Bushmore  Wood  who,  by  his  bright  example, 
showed  us  the  worth  and  dignity  of  Pathological 
research,  and  at  the  same  time,  by  his  inde- 
fatigable assiduity  and  zeal  in  the  face  of 
strenuous  opposition  secured  for  the  students 
and  teachers  of  anatomy  in  New  York  the 
facilities  and  advantages  they  now  enjoy. 


THE  HOMCEOPATHS  IN  THE 
MEDICAL  COUNCIL. 

As  the  Medical  Council  is  at  present  consti- 
tuted, there  are  twenty-two  representatives  of 
the  Regulars  and  five  Homoeopaths ;  and, 
although  in  proportion  to  the  constituency  the 
latter  represent,  they  relatively  out-number  the 
Regulars,  still  it  might  appear  that  such  a 
small  minority  in  such  an  assembly  would  have 
little  or  no  influence,  and  might  thereby  suf- 
fer very  materially.  Strange  to  say,  however, 
the  records  of  the  past  shew  that  this  same 
minority  not  only  knows  well  how  to  look 
after  its  own  interests,  but  also  has  often  been 
able  to  outwit  the  somewhat  ponderous,  and,  at 
times,  rather  dense  majority.  We  had  a  good 
example  of  this  last  June,  when  the  Council 
nearly  went  into  convulsions  over  an  attempt 
to  get  a  few  worthy  students  passed  who  had 
come  slightly  below  the  standard  in  one  subject, 
and  at  the  same  time  had  the  misfortune  to  be 
Regulars  ;  and  shortly  afterwards  decided  by  a 


large  majority  to  pass  Dr.  John  Hall,  who  had 
the  e;ood  fortune  to  be  a  Homoeopath,  by  Dr. 
Bray's  inexpensive  method,  which  practically 
meant  no  examination  at  all. 

We  hope  it  won't  surprise  the  Council  if  we 
venture  to  protest  against  such  acts,  and  ask 
its  members  to  be  as  kind  and  generous  towards 
the  Regulars  as  they  are  towards  the  Homoeo- 
paths, or  any  other  Irregulars.  What  is  the 
secret  of  such  extraordinary  conduct,  we  know 
not.  We  hear  vague  and  mysterious  rumors 
of  log-rolling,  balance  of  power,  &c.,  but  we  are 
unable  to  go  into  particulars.  It  is  said  by 
some,  who  perhaps  know,  that  those  who  wish 
to  become  initiated  may  learn  something  by 
watching  the  proceedings  at  the  next  session. 
It  is  even  stated  that  no  one  will  be  elected 
President,  who  has  not  succeeded  in  previously 
capturing  the  Homoeopaths.  We  don't  profess 
to  know  anything  about  the  matter,  but  will, 
with  others,  take  some  interest  in  looking  on, 
and  observing  the  actions  of  those  who  combine 
with  the  powerful  minority  in  order  to  attain 
their  ends,  and  the  price  they  pay  for  such 
assistance. 

We  have  to  acknowledge  that  in  these 
modern  days  the  Homoeopaths  appear  to  be 
gaining  strength.  They  have  taken  possession 
of  the  broad  and  lofty-minded  specialists  of 
New  York,  and  that  city's  Medical  Record, 
while  in  this  Province  they  have  acquired  a 
controlling  power  over  an  influential  Medical 
Journal,  which  claims  "  the  largest  circulation 
of  any  Medical  Journal  in  Canada."  Possibly 
we  may  be  allowed  to  hope  they  will  be 
checked  in  their  victorious  career  before  they 
have  scattered  to  the  winds  every  vestige  of 
principle,  upon  which  we  have  long  smd  fondly 
trusted  our  profession  was  securely  founded. 


TORONTO  MEDICAL  SOCIETY. 

At  the  annual  meeting  held  May  4th,  the 
following  were  elected  as  ofiicers  for  the  ensu- 
ing year  :  President,  Dr.  George  Wright  ;  1st 
Vice-President,  Dr.  A.  H.  Wright ;  2nd  Vice- 
President,  Dr.  W.  J.  Wilson ;  Recording  Sec- 
retary, Dr.  McPhedran  ;  Treasurer,  Dr. 
Spencer ;  Corresponding  Secretary,  Dr.  J. 
Robinson ;  Membera  of  the  Council,  Drs.  Clark, 
Smith  and  Davidson. 


204 


CANADIAN  JOURNAL 


ONTARIO  MEDICAL  ASSOCIATION. 

We  learn  with  pleasure  that  there  is  every 
prospect  of  a  very  successful  meeting  of  the 
Ontario  Medical  Association,  which  is  to  be 
held  in  Toronto,  June  7th  and  8th.  We  are 
again  indebted  to  our  Secretary,  Dr.  White, 
for  the  energy  he  has  shown  in  his  arduous  task 
of  completing  all  necessary  arrangements,  in- 
cluding those  with  Railway  Companies  for 
reduced  fares.  For  particulars  we  refer  our 
readers  to  advertisement  in  this  issue.  A  num- 
ber of  physicians  have  been  invited  from  Mon- 
treal and  other  cities  in  Canada  and  the 
United  States,  and  several  have  promised  to 
attend.  The  following  papers  have  thus  far 
been  promised : 

Dr.  Ryerson,  Toronto — Adenoma  of  the  Vault 
of  the  Pharynx.     Dr.     W  orthington,    Clinton 

Dr.    Philip,     Brantford— On 

the  Anti-septic  Treatment  of  Phthisis.  Dr. 
Curry,  Rockwood — Science  of  Medicine.  Dr. 
Harris,  Brantford — Retro versio  Uteri.  Dr. 
Temple,  Toronto — Remarks  on  Treatment  of 
Laceration  of  Cervix  Uteri.    Dr.  Powell,  Edgar 

Remarks  on  Haemorrhage  after  Tonsillotomy. 

Dr.  Daniel  Clark, Toronto — On  the  Therapeutics 
of  Insanity.  Dr.  Snow,  New  York — Trachelor- 
rhaphy, or  Operation  for  Laceration  of  Cervix 

Uteri.       Dr.     Dupuis,    Kingston  .       Dr. 

Palmer,  Toronto  —  Liglit  in  Schools.  Dr. 
Stewart,  Brucefield — Case  of  Locomotor  Ataxia. 

Reports  of :  1st.  Successful  reductions  of  a  dis- 
location of  the  elbow  (radius  and  ulna  back- 
wards) after  four  weeks  duration.  2nd.  Perfect 
restoration  of  Perinaeum  after  complete  lacera- 
tion of  five  months'  standing.  3rd.  Excision 
of  the  elbow  for  caries  of  the  articular  ends  of 
the  humerus  and  ulna,  with  a  useful  arm. 

Dr.  Clark,  Oshawa — Venesection  :  Its  past 
Abuses  and  present  Uses.  Dr.  Canniff,  Toronto 
Remarks  on,  and  Exhibition  of  Case  in  Sur- 
gery. Dr.  Yeomans,  Mount  Forest — The  Rela- 
tion of  Local  Boards  to  the  Provincial  Board  of 
Health.  Dr.  R.  W.  B.  Smith,  Sparta — Alcohol 
in  Diseases.  Dr.  Harrison,  Selkirk — Case  of 
Eclampsia.  Dr.  MacKelcan,  Hamilton — 
Treatment  of  Diphtheria.  Dr.  Oldright,  To- 
ronto— Some  points  regarding  Measurements 
in  Surgical  Practice.  Dr.  Playter,  Toronto — 
Remarks  on  some  Points  in  Vital  Statistics  in 
Ontario. 


MEDICAL  COUNCIL  EXAMINERS. 

One  of  the  most  unsatisfactory  features  in 
the  past  history  of  the  proceedings  of  the 
Ontario  Medical  Council  has  been  the  frequent 
changes  in  the  Board  of  Examiners.  One  year 
the  Board  will  reject  a  third  to  half  the 
candidates,  and  perhaps  the  following  year  a 
new  Board  will  pass  everybody.  There  is  no 
doubt  that,  all  things  considered,  the  Ex- 
aminers, who  lately  handed  in  their  report, 
are  the  best  men  who  have  conducted  an  ex- 
amination for  that  body.  Under  such  cir- 
cumstances, to  make  any  sweeping  changes  is 
worse  then  useless,  and  would  add  a  vague 
uncertainty,  which  is  not  only  perplexing, 
but  might  prove  positively  injurious.  If  it 
should  happen  that  one  or  two  are  unwilling 
to  act  again,  men  who  are  known  to  be 
eminently  fit  lor  the  position  should  be  ap- 
pointed to  take  their  places.  The  appointments 
should  be  made  for  a  long  period,  say  ten  years, 
and  changes  should  be  made  gradually.  An 
absurd  rule  prevents  "  School  men "  from 
examining  in  the  subjects  they  know  most 
about,  but,  at  the  present  time,  the  three 
teachers  who  examine  are  well  known  to  be 
thoroughly  qualified  for  the  suljects  allotted  to 
them,  and  we  hope  they  will  be  retained.  If 
any  changes  must  be  made,  we  hope  that  care 
will  be  taken  in  making  a  suitable  choice 
without  any  regard  to  local  prejudices  or  elec- 
tioneering exigencies. 


Clinical  Teaching  Falsely  So-called. — 
Almost  every  day,  says  the  London  Lancet,  a 
visitor  to  the  wards  and  class-rooms  of  the 
Metropolitan  hospitals  may  observe  the  melan- 
choly spectacle  of  a  crowd  of  students  collected 
around  their  teacher,  who  is  engaged,  not  in 
expounding  the  fundamental  principles  of 
surgery  or  medicine,  nor  yet  in  explaining  the 
scientific  methods  of  the  investigation  of  mor- 
bid phenomena,  but  in  doling  out  to  empty 
minds  promiscuous  scraps  of  disorderly  infor- 
mation, known  as  "  tips  for  the  college."  If 
this  be  the  usual  mode  of  medical  education  in 
these  days,  it  is  not  surprising  that  the  per- 
centage of  rejections  should  steadily  rise. 


OF  MEDICAL  SCIENCE. 


205 


CLINICAL    CLERKS    AND    SURGICAL 
DRESSERS. 

While  our  students  are  improving  every  year 
in  their  knowledge  of  piactical  work,  the 
results  of  the  recent  examinations  show  a 
deficiency  of  aptitude  in  examining  patients 
and  using  ordinary  surgical  appliances,  on  the 
part  of  some  of  the  candidates,  which  is  in- 
excusable, considering  the  vast  opportunities 
now  placed  at  their  disposal.  We  hope,  there- 
fore, that  the  Medical  Council  will  adopt  the  rule 
carried  out  in  Great  Britain,  and  require  from 
every  candidate  presenting  himself  for  the  final 
examination  a  certificate  of  having  served  a  term 
of  three  months  each  as  clinical  clerk  and 
surgical  dresser  in  some  regular  hospital.  It 
would  probably  be  too  much  to  ask  for  both 
certificates  next  year ;  but  one,  at  least,  should 
be  required,  and,  after  the  examination  in  1883, 
the  two  should  be  demanded.  Such  a  system 
would  not  only  prove  vastly  beneficial  to  the 
student,  but  would  also  assist  the  working 
staff  of  the  hospital  by  compelling  those  attend- 
ing such  institutions  to  do  ordinary  dressing 
and  note-taking  properly. 


RoTHELN  OR  GERMAN  Measles. — An  epi- 
demic of  German  measles  has  been  very  preva- 
lent in  Toronto,  during  the  last  few  weeks,  and 
a  few  cases  have  presented  symptoms  unusually 
severe.  One  case,  occurring  in  the  practice  of 
Dr.  McFarlane,  terminated  fatally  after  an  ill- 
ness of  four  days.  Two  other  fatal  cases  have 
been  reported,  one  being  an  adult.  Catarrhal 
symptoms  have  been  occasionally  well  marked, 
but  generally  slight.  The  throat  has  been 
severely  affected  in  a  few  cases.  The  eruption 
has  presented  the  ordinary  appearances,  first 
resembling  that  of  scarlet  lever,  and  in  a  few 
hours  becoming  more  like  that  of  ordinary 
measles.  In  certain  respects  it  has  varied 
greatly  in  different  cases  ;  sometimes  only  a 
few  spots  were  visible,  sometimes  it  was 
very  copious  over  the  whole  body.  It  has 
first  appeared  generally  in  face,  often  on  body, 
and  sometimes  the  extremities,  on  palms  of 
hands,  and  soles  of  feet.  Usually  convalescence 
has  been  rapid.  So  far  as  we  know  so  general 
an  epidemic   of  this  disease   has  never  been 


known  in  Toronto ;  but  it  is  hard  to  speak 
positively  on  this  point,  because,  in  times  past, 
it  was  so  frequently  confounded  with  scarlatina 
and  measles,  and  certainly  the  old  description  of 
a  hybrid  combination  of  these  two  diseases  has 
seemed  very  applicable  in  the  recent  epidemic. 
The  peculiarities  arising  from  this  fact  often 
make  a  certain  diagnosis  very  difficult,  especially 
in  the  first  cases  which  come  under  observation. 
If,  however,  we  agree  with  Murchison  and 
others  who  have  asserted  that  Rotheln  furnishes 
no  immunity  from  either  scarlet  fever  or 
measles,  we  must  attach  great  importance  to 
a  correct  diagnosis. 


Gives  Canadekses  Sumus. — We  are  some- 
what amused  to  observe,  in  the  New  York 
Medical  Record,  for  May  13th,  in  an  editorial 
article,  discussing  the  merits  of  Benedict's 
views  on  the  anatomical  characteristics  of  the 
brains  of  criminals.  Dr.  Wra.  Osier's  investi- 
gations of  the  sixbject  referred  to  as  "  a  recent 
contribution  by  an  American,  Dr.  Wm.  Osier, 
of  Montreal."  Now,  although  we  fully  recognise 
the  cosmopolitan  character  of  science,  yet  we 
would  venture  to  suggest  to  our  "big brother  " 
Shrady,  that  notwithstanding  the  great  aplomb 
with  which  we  are  wont  to  suffer  our  cousins 
across  the  border  to  arrogate  to  themselves  the 
title  of  American,  we  cannot  with  equal  un- 
concern allow  them  to  appropriate  also  the  few 
men  of  science  we  happen  to  possess.  In  an 
article,  therefore,  in  which  he  distinguishes  be- 
tween Austrian  and  American,  we  would 
prefer  to  see  our  countryman  denominated 
either  a  Canadian  or  a  Briton.  In  matters 
of  science,  and  especially  of  medical  science, 
as  well  as  in  things  political,  the  adjective 
British  is  still  dear  to  our  hearts,  and 
we  are  by  no  means  content  to  trace  the 
roots  of  our  genealogical  tree,  in  unbroken  con- 
tinuity, through  the  soil  of  time  no  further 
back  than  the  year  of  grace  1776. 


Medical  Bishops. — I.  M.  Strachan,  M.D., 
Rangoon ;  Dr.  Oalliway,  Kaff-tria  ;  Dr.  Stir- 
ling, Falkland  Isles;  and  Dr.  McDougall, 
formerly  of  Labuan  and  Sarawak,  now  Arch- 
deacon of  the  Isle  of  Wight. 


206 


CANADIAN  JOURNAL 


A  Model  Clinical  Examination. — The 
examinalion  for  the  Murchison  Scholarship  in 
clinical  medicine  was  lately  conducted  by  Di-s. 
Wilks  and  Bristowe,  and  comprised  three 
parts :  "  An  oral,  in  which  recent  pathological 
specimens,  museum  preparations,  and  micro- 
scopic sections  were  examined  and  reported  on 
by  each  candidate  ;  a  written,  in  which  three 
questions  on  clinical  medicine  were  set ;  and  a 
practical,  in  which  each  candidate  was  re- 
quired to  examine,  write  a  report,  and  com- 
ment on,  two  cases  in  the  medical  wards  of 
St.  Marylebone  Infirmary.  In  addition  to 
these  three  specially  selected  cases  of  typical 
diseases  were  shown  to  each  candidate  in  rota- 
tion, and  on  these  he  had  also  to  furnish  a 
written  commentary." 


Murchison  Scholarship. — Mr.  Charles  F. 
Coxwell,  of  St.  Thomas's  Hospital,  late  one  of 
the  Assistant  Under-Secretaries  of  the  Inter- 
national Medical  Congress,  enjoys  the  proud 
distinction  of  being  the  first  holder  of  the 
Murchison  Scholnrship  lately  founded  in 
honour  and  memory  of  that  great  Clinician. 
It  Ls  peculiarly  fitting  that  a  pupil  of  that 
school,  in  which  the  foremost  clinical  teacher 
of  his  time  established  his  reputation,  should  be 
the  recipient  of  an  honour  commemorative  of 
his  '*  name  and  use  and  fame." 


Boroglyceride  (C3  H,  BO,)  +  3  HjO,  is 
the  name  given  by  Prof.  Barff  (of  BarflTs-Iron 
fame)  to  the  new  antiseptic  lately  introduced 
by  him.  "  At  ordinary  temperatui'es,"  says 
the  London  Lancet,  "boroglyceride  is  an 
odourless,  transparent,  jelly-like  body,  almost 
without  taste,  although,  when  placed  upon  the 
tongue  in  its  pure  state,  it  leaves  behind  a 
*  smack '  not  unlike  that  caused  by  alum." 
Mr.  Barwell,  of  Charing  Cross  Hospital,  speaks 
most  highly  of  its  use  in  clinical  surgery.  He 
employed  a  5  per  cent,  solution. 

The  Safest  Anaesthetic  Known. — Dr. 
Richardson  says  that  Methyline  bichloride, 
ten  fluid  drachms,  and  absolute  methylic 
alcohol,  six  fluid  drachms,  constitute  the  safest 
known  anaesthetic  when  the  methylic  alcohol 
is  absolutely  pure. — Lancet. 


We  have  to  apologise  to  one  of  the  Medical 
Sdiools  in  Detroit,  for  references  made  to  it 
in  our  note  on  "  Manufacturing  Doctors,' 
which  appeared  in  our  last  issue.  The  school 
we  referred  to  is  in  Buff'alo,  not  Detroit.  We 
received  our  information  from  two  different 
sources,  and  thought  it  reliable.  The  error 
arose  from  a  singular  similarity  of  names 
which  we  cannot  explain  more  explicitly.  We 
regret  exceedingly  that  such  a  mistake  should 
have  occurred. 


New  Medical  School  in  New  York. — It 
{s  expected  that  a  new  medical  department  of 
Cornell  University,  Ithaca,  will  be  located  in 
New  York,  and  will  be,  to  a  large  extent,  under 
the  charge  of  the  eight  members  of  the  post" 
graduate  faculty  of  the  University  Medical 
College,  who  resigned  because  they  were  unable 
to  carry  out  a  system  of  post-graduate  teaching 
as  they  wished.  The  new  institution  will  be 
well  endowed,  and  from  present  appearance  is 
likely  to  be  highly  successful. 


All  medical  practitioners,  resident  in  this 
Province,  whose  addresses  are  not  given  in  the 
Ontario  Medical  Register,  are  requested  to 
communicate  with  the  Secretary  of  the  Pro- 
vincial Board  of  Health,  Dr.  P.  H.  Bryce, 
Toronto,  in  order  that  they  may  receive  docu- 
ments published  by  the  Board. 

.  <♦»  . 

A  Canadian   agency,   with   headquarters  in 

Toronto,  10  Colborne  Street,  under  the  charge 

of  Mr.   H.   P.  Gisborne,  has  been  established 

for  the  two  New  York  firms,  Messrs.  Reed  «k 

Carnrick,  Manufacturers  of    Ma) tine,  and  the 

Pharmacal  Association,  Manufacturers  of  Lac- 

topeptine. 

>  <>►< 

It  is  our  intention  to  publish,  for  the  special 

advantage   of  general    practitioners,  a  series  of 

selections  on  the  common  affections  of  the  eye, 

ear,  throat,  and  nose,  from  papers  read  before 

the  Toronto  Medical  Society.     We  inaugurate 

the  series  to-day  with  the  first  part  of  a  paper 

by  the  well-known  specialist,  Dr.  R.  A.  Reeve. 


The  jubilee  of  Henle's  graduation  as   M.D. 
was  celebrated  in  Gottingen  on  April  4th. 


OF  MEDICAL  SCIENCE. 


20T 


Erratum. —  In  our  last  issue  we  made  a  mis- 
take with  reference  to  the  3rd  years'  scholar- 
ship in  the  Toronto  School  of  Medicine.  The 
successful   candidate  was   Mr.  J.   M.  Jackson, 

of  Arva. 

»-♦♦>-< 

Dr.  B.  E.  McKenzie,  of  Aurora,  delivered  a 
lecture  on  "  The  Functions  of  the  Brain,"  at  the 
meeting  of  the  Science  Association  of  the  Uni- 
versity of  Victoria  College,  Cobourg,  on  Wed- 
nesday evening,  May  17  th. 


At  a  recent  meeting  of  the  University  Senate, 
Dr.  Wilson  gave  notice  of  a  motion  recom- 
mending the  establishment  of  a  professorship 
or  lectureship  on  constitutional  history  and 
jurisprudence. 


The  American  Medical  Association  will  meet 
in  St.  Paul,  Minn.,  on  the  6th.,  7th.,  8th.,  and 
9th.  of  June. 

We  regret  that  we  are  compelled  to  hold 
over  our  Book  Reviews  till  next  issue. 


PERSONAL. 

Drs.  L.  A.  Say  re  and  A.  B.  Mott,  retire  to 
tbe  Consulting  Staff,  at  Bellevue. 

Cornil  has  succeeded  Charcot  in  the  chair  of 
Pathological  Anatomy. 

Herbert  Nickle,  of  the  Toronto  School,  passed 
the  Primary  Examination  of  the  R.  C.  S.  on 
24th  April. 

Eppinger,  of  Graz,  has  been  appointed  to 
the  chair  of  Pathology,  in  Prague.  Weichsel- 
baum  will  probably  succeed  Kundrat  in  Graz. 

Dr.  Hugh  Watt  has  been  appointed  Surgeon 
of  the  General  Hospital  in  Cariboo,  British 
Columbia. 

James  M.  Smith,  of  the  village  of  Hyde 
Park,  Esquire,  M.D.,  to  be  an  Associate 
Coroner  in  and  for  the  county  of  Simcoe. 

Harry  D.  Eraser,  ef  the  town  of  Perth, 
Esquire,  M.D  ,  to  be  an  Associate  Coroner  in 
and  for  the  county  of  Lanark. 

Dr.  J.  Robinson  has  been  appointed  second 
Assistant  in  the  Toronto  Asylum  for  Insane 
in  the  place  of  Dr.  Covernton,  who  is  now  prac- 
tising in  Winnipeg. 


38rh  "  Brant"  battalion,  «  Dufferin  Rifles," 
No.  6  Company,  Brantford,  to  be  surgeon, 
Assistant  Surgeon  William  T.  Harris,  vice  Jas. 
Winniett  Digby,  whose  resignation  is  accepted. 

Mr.  Andrew  Robertson  has  been  elected 
President  of  the  Board  of  the  Montreal  Gen- 
eral Hospital  in  the  place  of  Mr.  Peter  Red- 
path,  who  is  now  residing  in  England. 

Brown  Sequard  has  been  appointed  Court 
Physician  at  Madrid,  but  has  declined  the 
honour.  The  world  moves. — {Gaillard'a  Med- 
ical Journal.) 

Secretary  Teller,  of  the  United  States  Trea- 
sury, has  appointed  Dr.  Mary  Walker  to  a 
position  in  the  Pension  Office  in  consequence 
of  strong  representations  as  to  her  destitute 
circumstances. 

Prof.  Wagner,  of  Leipsic,  says  the  N.  Y. 
Medical  Record,  has  been  fined  $12  for  calling 
homoeopathy  a  swindle,  &c.  He  was  sued  by 
75  homoeopaths,  among  whom  the  spoils  are 
presumably  to  be  divided. 

Hr.  Giovanni  Lanza,  the  Italian  Prime 
Minister,  who  died  March  9,  1882,  had  nearly 
completed  his  semi-centennial  as  a  physician, 
having  graduated  in  medicine  in  the  city  of 
Florence  in  1834. — Chicago  Med.  Review. 

Dr.  N.  H.  Beemer,  of  the  Asylum  for  the 
Insane,  London,  has  recently  passed  his  first 
intermediate  examination  for  barrister-at-law. 
It  might  be  well  if  more  of  those  likely  at  any 
moment  to  be  called  upon  to  assume  the  role  ot 
medico-legal  jurists,  should  do  likewise. 

Dr.  A.  Jukes,  of  St.  Catharines,  who  haa 
been  appointed  staff  surgeon  of  the  North-West 
Mounted  Police,  was  on  Monday  presented  by 
a  few  of  his  friends  with  a  complete  outfit  for 
a  staff  surgeon,  and  w/is  afterwards  entertained 
at  luncheon. 

Dr.  Cossar  Ewart  has  finally  been  appointed 
to  the  chair  of  Natural  History  in  the  Univer- 
sity of  Edinburgh,  Prof.  Ray  Lankester  having 
resigned  the  appointment  after  a  few  days. 
We  had  hoped  Prof.  Alleyne  Nicholson  would 
have  been  Sir  Wyville   Thomson's   successor. 

Dr.  Jas.  F.  Bell,  from  the  Toronto  School  of 
Medicine,  and  Dr.  E.  R  Woods,  from  t}ie 
Trinity  Medical  School,  were  recently  appoint- 
ed Clinical  Assistants  at  the  Toronto  General 
Hospital.  The  senior  assistant  is  Dr.  Mac- 
douald  and  one  other  to  be  appointed. 


208 


CANADIAN  JOURNAL 


UNIVERSITY  OF  TORONTO. 

RESULTS   OF  THE    RECENT    EXAMINATIONS  IN  THE 
FACULTY  OF  MEDICINE. 

The  following  are  the  results  of  the  annual 
examinations  in  the  Faculty  of  Medicine,  Uni- 
versity of  Toronto  : — 

First  year — Passed,  H.  Bascom,  C.  H.  Brit- 
ton,  A.  Brcadfoot,  E.  Bourke,  L.  Carr,  G.  A. 
Cherry,  F.  W.  Cane,  J.  D.  Courtney,  W.  A. 
Goodall,  H.  N.  Hoople,  A.  B.  Knisley,  C.  A. 
Krick,  D.  Minchin,  D.  Poole,  M.  R.  Saunders, 
J.  E.  Sutherland,  D.  M.  Stabler,  H.  E. 
Webster. 

J.  \V,  Patterson  and  S.  Stewart,  second  year, 
passed  in  anatomy.  J.  H.  Howell  obtained 
segrotat  standing  in  this  year.  Goodall  and 
Knisley  take  chemistry  again. 

Scholai'ships — 1st,  H.  W.  Hoople ;  2nd,  L. 
Oarr. 

Second  year — Passed,  J.  Braj ,  J.  W.  Gierke, 
J.  S.  Draper,  J.  Johnston,  T.  D.  Michael, 
A.  F.  MiKenzie,  J.  W.  Paterson,  R.  L.  Stew- 
art, S.  Stewart,  J.  Spence,  A.  S.  Thompson, 
R,  Hearn. 

W.  Johnston,  T.  M.  Milroy,  and  W.  H. 
Oliphant,  of  ith  year,  passed  on  physiological 
chemistry. 

Scholarships — 1st,  J.  W.  Gierke  ;  '2nd,  A. 
F.  McKenzie. 

Third  year— Passsd,  H.  S.  Gierke,  S,  J. 
Dolsen,  J.  E.  Hansler,  J.  A.  Meldrum,  W.  J. 
Robinson. 

Scholarships — 1st,  W.  J.  Robinson ;  2nd, 
F.  J.  Dolsen. 

Primary — W.  H.  Garleton,  W.  F.  Freeman. 
Final — Passed,  W.  J.  Charlton,  R.  Coulter, 
A.  I.  Freele,  N.  S.  Frost,  W.  Gilpin,  H.  P. 
Jackson,  J,  G.  Mennie,  A.  S.  Nasmith,  J.  W. 
Rae,  S.  R.  Rogers,  J.  E.  Shore,  P.  C. 
Walmsley. 

Fourth  year — Passed,  J.  F.  Bell,  G.  S. 
Oleland,  J.  T.  Duncan,  W.  F.  Eastwood,  R. 
M.  Fisher,  W.  Hanbridge,  W.  H.  Johnson, 
E.  G.  Knill,  F.  D.  Kent,  J.  Laferty.  F.  M. 
Milroy,  T.  F.  McMahon,  W.  H.  Oliphant,  A. 
C.  Panton,  R.  R.  Wallace. 

University  gold  medal — R.  R.  Wallace. 

University  silver  medal — J.  F.  Duncan. 

Starr  gold  medal — R.  R.  Wallace. 


Degieo  of  M.D. — J.  Andei-sou,  M.B. 

Of  the  prizemen,  Mr.  Wallace  (double  gold 
medallist)  and  Mr.  H.  W.  Hoople  were  from 
the  Trinity  Medical  School;  Mr.  Duncan 
(Silver  Medallist),  Messrs.  Robinson,  Dolsen, 
Clarke,  McKenzie,  and  Carr,  were  from  the 
Toronto  School  of  Medicine.  In  graduating 
class  there  were  6  from  Trinity,  21  from 
Toronto ;  undergraduates,  8  from  Trinity,  30 
from  Toronto. 


TRINITY  COLLEGE. 

CONVOCATION  FOR  CONFERRING  MEDICAL  DEORES- 

The  names  of  those  who  took  the  degree  of 
M.B.  were  as  follows  : — 

Archibald  Charles  Caviller,  gold  medallist  ; 
James  Murray  Johnston,  silver  medallist. 

The  following  gentlemen  received  certificates 
of  honour  in  addition  to  the  degree  : — W.  H. 
Macdonald,  A.  D.  Smith,  J.  T.  Sutherlmd,  J. 
Johnston,  W.  M.  Brett,  P.  J.  Strathy,  J.  W. 
Ray,  T.  M.  Milroy,  H.  H.  Graham. 

The  following  passed  simply  : — H.  H.  Atkin- 
son, R.  W.  Belt,  F.  D.  Canfield,  T.  W.  Dun- 
combe,  J.  G.  Davidson,  J.  A.  Gracey,  J.  W. 
L.  Hunter,  Wm.  Nattrass,  A.  F.  Pringle,  J. 
Urquhart,  H.  C.  Wilson,  J.  D.  Wilson,  E.  R. 
Woods,  and  D.  McLeod. 

T'le  following  gentlemen  received  the  degrees 
of  C.  M.,  M.D.  :— H.  P.  McCausland,  J. 
Walker,  F.  E.  Woolverton,  F.  C.  Astley,  J.  C. 
Urquhart,  George  McLaine,  A.  H.  Ferguson, 
W.  Honeywell,  J.  Bonnar,  J.  A.  McNaughton, 
C.  M.  Freeman,  T.  H.  Stark. 

The  following  took  C.  M.  alone : — R.  J. 
McKinnou  and  R.  A.  Ross. 

The  following  took  the  degree  of  M.D.  : — 
R.  B.  Nevitt,  R.  Raikes. 


UNIVERSITY  OF  VICTORIA  COLLEGE 

CONVOCATION  FOR  CONFERRING 

DEGREES. 

The  following  received  the  degree  of  M.D., 
CM.,  being  presented  by  Dr.  Uzziel  Ogden,  of 
the  Toronto  School  of  Medicine  : 

W.  H.  Aikins,  R.  J.  Burton,  R.  M.  Coulter, 
J.  T.  Carroll,  M.  K.  Collver,  James  Campbell, 
G.   W.  Clendenan,  M.  R.  Elliott,  H.  P.  Jack- 


OF  MEDICAL  SCIENCE. 


209 


son,  W.  J.  Kellow,  W.  H.  Montague,  G.  S. 
McDonald,  B.  Rose,  S.  R.  Rogers,  W.  A. 
Ross,  J.  W,  Wilmot,  J.  B.  W.hiteley,  Chas.  J. 
Wilson,  CM.;  J.  H.  Radford,  G.  M.  Milne, 
W.  D.  Fowler,  J.  M.  Piper,  M.D. ;  J.  E. 
Savai'd,  O.  H.  Manzan,  J.  H.  H.  Gauthier,  W, 
Dubeau,  J.  B.  E.  Maillet,  and  E.  P.  Vannier. 


(Dhitomis. 


Dr.  John  T.  Hodgen,  of  Sr.  Louis,  died  April 
28th,  in  the  fifty-seventh  year  of  his  age.  He 
was  a  prominent  and  well  known  surgeon,  and 
was  Professor  of  Surgical  Anatomy  in  the  St. 
Louis  Medical  College.  He  was  President  of 
the  American  Medical  Association  in  1881,  and 
presided  at  the  meeting  held  that  year  in  Rich- 
mond. 


Dr.  John  Brown,  of  Edinburgh,  well  known 
as  a  physician,  but  better  still  as  the  author  of 
"  Rab  and  his  Friends,"  and  the  other  contents 
of  his  two  volumes  of  "Spare  Hours,"  has 
gone  to  his  rest  at  the  age  of  72,  loved  and 
honoured  by  those  amongst  whom  he  wrought, 
and  more  distantly,  but  not  less  devoutly,  by 
those  for  whom  he  wrote.  He  was  a  contri- 
butor to  the  North  British  Review,  Good  Words, 
and  the  Scotsman. 


James  Rushmore  Wood,  M.D,,  LL.D. — The 
profession  in  New  York  has  paid  another  heavy 
tribute  to  the  debt  of  nature  in  the  person  of 
the  above-named  eminent  surgeon,  who  suc- 
cumbed to  double  pneumonia  on  the  ult. 
Dr.  Wood  was  born  of  Quaker  parents,  in  New 
York  City,  on  14th  Sept.,  1816,  and  graduated 
at  Castleton  (Vt.)  Medical  College  in  1846, 
being  appointed  Demonstrator  of  Anatomy 
there  the  same  year.  In  1847  he  became 
identified  with  Bellevue  Hospital,  and  from 
that  time  till  his  death  held  a  prominent  posi- 
tion on  its  surgical  stafi".  He  was  twice  Presi- 
dent of  the  Pathological  Society,  and  was 
Consulting  Surgeon  to  Charity,  St.  Vincent's, 
Woman's,  and  Ruptured  and  Crippled  Hospi- 
tals. He  wrote  but  little,  but  his  eminence  as 
a  surgeon,  in  the  fullest  sense  of  the  word,  was 
universally  conceded. 


;00fe  %t>\\m. 


Hygiene  in  Relation  to  the  Eye.     By  C.  J. 
LUNDY,  M.  D. 


The  Death-rate  of  Memphis.  By  Geo.  E, 
Waring,  Jr.,  Newport,  R.  I.  (Reprint  from 
American  Architect.) 


Current  Fallacies  about  Vaccination.  A 
letter  to  Dr.  W.  B.  Carpenter,  C.^B.  By  P. 
A.  Taylor,  M.P. 


Observations  on  Surgery  in  Children.  By 
Edward  Borck,  M.D.  (Reprint  from  St. 
Louis  Medical jind  Surgical  Journal.) 


The  Special  Therapeutic  Value  of  Hyoscyamint 
in  Psychiatry.  By  C.  H.  Hughes,  M.D. 
(Reprint  from  Alienist  and  Neurologist.) 

Report  of  the  Asylum  for  the  Insane,  London 
for  year  ending  ?tOth  September,  1881.  By  R. 
M.  Bucke,  M.D.,  Superintendent. 

Gonorrhaal  Ophthalmia,  its  Complications 
and  Results',  Iridectomy  for  Artificial  Pupil. 
By  C.  J.  LuNDY,  M.D.  (Reprint  from  Mich- 
igan Medical  News.) 

Galvano  Caustic  Method  in  Nose,  Pharynx 
and  Laryrvx.  By  J.  Solis  Cohen,  M.D.,  of 
Philadelphia.  Read  at  International  Medical 
Congress,  London.     J.  W.  Kolckmann. 


The  Opium  Habit ;  Its  Successful  Treatment 
by  the  Avena  Sativa.  By  E.  H.  M.  Sell, 
A.M.,    M.D.,     (Reprint     from     the    Medical 

Gazette. 

The  Separate  System  of  Sewerage.  By  Geo. 
E.  Waring,  Jr.  (A  reply  to  the  paper  of 
Eliot  C.  Clarke,  Esq.)  (Reprint  from 
American  Architect),  Newport,  R.  I.,  1882. 


Working  Bulletins  for  the  Scientific  Investi- 
gation of  Jamaica  Dogwood,  Quebracho,  and 
Cascara  Sagrada.  By  Messrs  Parke,  Davis 
and  Co.,  Detioit,  Michigan,  U.  S. 

Del  Histerismo  Considerado  en  sus  Relaci- 
ones  con  Algunas  Enfermedades  Localizadas. 
Por  el  Dr.  D.  Federiot  Castells.  Barcelona 
(Reprint  from  *•  Gaceta  Medica  Catalana.") 


210 


CANADIAN  JOURNAL 


Ittrctiugisi  0f  Prilial  ^mttitf^. 


REPORT  OF  TORONTO  MEDICAL 
SOCIETY. 

February  9th,  1882.— The  Society  met  at 
8.15  p.m.,  the  President  in  the  chair;  the 
minutes  of  the  last  meeting  were  read  and 
adopted. 

Dr.  Workman  then  gave  notice  that  three 
months  hence  he  would  move  that  the  annual 
fee  for  membership  of  this  Society  be  reduced 
from  $3  to  $2. 

Dr.  Graham  exhibited  two  vesical  calculi  re- 
moved at  post-mortem  examination  from  a  lad, 
aged  seventeen;  the  larger  one  was  firmly  fixed 
and  encysted  below  the  pubic  arch  and  was 
taken  for  an  exostosis.  The  same  gentleman 
also  showed  a  left  lung  and  aorta ;  the  aorta  was 
aneurysmal  and  had  ruptured  into  the  pleural 
cavity,  the  patient  from  whom  the  specimen 
was  taken  also  suffered  from  pleurisy  with 
effusion ;  the  patient's  voice  was  hoarse  due  to 
pressure  on  the  recurrent  laryngeal  by  the 
aneurysm. 

Dr.  Burns  showed  a  young  man,  aged  nine- 
teen, with  hypertrophic  enlargement  of  the 
ulnae  'and  tibiae,  no  clue  could  be  got  to  the  dis- 
ease from  the  family  history,  no  evidence 
of  syphilis,  except  slight  protrusion  of  the 
frontal  eminences  and  the  bridge  of  the  nose 
being  sunken. 

Di-.  Wilson,  showed  a  foetus  with  an  abscess 
in  the  left  thigh,  with  arrest  of  development  in 
the  affected  limb. 

Dr.  Nevitt  then  showed  a  ruptured  uterus. 
The  child's  body  and  part  of  the  placenta  had 
escaped  through  the  rent  into  the  abdominal 
cavity.  No  decided  cause  could  be  given  for 
the  accident,  a  microscopic  examination  showed 
fatty  degeneration  and  inflammatory  infiltra- 
tion. The  rent  extended  through  part  of 
plcental  attachment. 

Dr.  Oldright  showed  a  large  tumour,which  at 
first  was  thought  to  be  fatty,  but  on  microscopic 
examination  it  was  found  to  be  a  mixed 
myxo-lympho  sarcoma  in  structure ;  it  was 
removed  from  the  upper  part  of  the  thigh, 
situated  beneath  the  abductor  longus,  weight, 
four  and  a-balf  pounds. 


Dr.  Cameron,  then  showed  a  case  of  palmar 
squarao-pustular  syphilide.  No  history  of 
syphilis  was  obtainable;  but  the  patient  im- 
proved greatly  under  a  mixture  containing  the 
perchloride  of  mercury  and  the  iodide  of  potas- 
sium; the  case  also  showed  serpiginous  eczema 
on  the  extensor  surfaces  of  the  arms. 

Dr.  McPhedran  related  a  case  in  which  there 
was  loss  of  power  of  the  lower  extremities  after 
confinement ;  he  could  assign  no  cause  for  the 
malady. 

Dr.  Temple  mentioned  a  similar  case  which, 
after  some  months,  quite  regained  the  use  of 
the  limbs,  no  special  treatment  being  adopted. 

The  Pi-esident  then  vacated  the  chair  and 
read  a  short  paper  upon  "  The  Difference 
between  Acute  Delirium  and  Insane  Delirium." 
Af  er  a  few  preliminary  remarks,  he  described 
the  different  effect  alcohol  had  upon  different 
persons,  and  gave  a  vivid  description  of  an 
individual  case,  he  also  gave  a  description  of 
the  mania  of  hysteria  and  delirium  tremens  and 
concluded  his  paper  by  giving  the  points  in  the 
differential  diagnosis  between  acute  and  insane 
delirium.     The  Society  then  adjourned. 

February  23rd,  1882.— The  Society  met  at 
8.30.,  Dr.  Graham  in  the  chair.  The  minutes  of 
the  last  meeting  were  read  and  adopted 

Dr.  Davidson  then  exhibited  a  placenta  which 
had  been  adherent  to  the  uterine  wall  through- 
out nearly  its  whole  exent,  masses  of  fibrinous 
lymph  were  to  be  seen  on  its  surface,  and  in 
order  to  remove  the  placenta  it  was  necessary 
to  introduce  the  whole  hand  into  the  uterine 
cavity.  A  discussion  then  ensued  as  to  the  merits 
and  demerits  of  introducing  the  hand  into  the 
uterus  to  remove  adherent  placentae. 

Dr.  Riddel,  showed  the  h^ad  of  an  aged 
man,  whose  widow  was  committed  for  trial 
on  a  charge  of  murdering  him,  on  the 
medical  evidence  given  at  the  inquest  which 
stated  that  the  right  temporal  bone  had  been 
fractured,  the  result  of  several  blows  from  some 
blunt  instrument.  On  a  close  examination  of 
the  skull  by  Dr^  Riddel  it  was  found  that 
there  was  no  fracture  of  the  right  tempora 
bone,  but  that  a  small  fragment  of  the  parietal 
bone  was  wanting  which  must  have  been  frac- 
tured at  the  time  that  the  calvarium  was  re- 
moved by  the  operator,  which  had  it  been  frac- 


OF  MEDICAL  SCIENCE. 


211 


tured  before  the  post-mortem  would  have 
crumbled  away  or  been  detached  from  the  dura 
mater  by  the  action  of  the  saw.  Dr.  Riddel 
also  found  a  fracture  of  the  left  parietal, 
frontal,and  occipital  bones  which  must  have  been 
produced  by  the  unskillful  removal  of  the  skull 
cap,  at  the  trial  of  the  supposed  murderess. 
Dr.  Riddel  was  called  for  the  defence,  and  gave 
bis  evidence  in  accordance  with  wh&t  he  found 
as  above  stated,  upon  which  and  together  with 
similar  evidence  by  Dr.  W.  T.  Aikins  the 
woman  was  acquitted. 

Dr.  Oldright  then  made  some  observations  as 
to  the  condition  of  the  prepuce  in  early  boyhood. 
He  thought  it  was  a  very  common  thing  to  find 
the  prepuce  contracted  in  children,  and  that 
needless  operations  were  often  performed ;  he 
thought  that  as  age  advanced,  the  condition 
generally  righted  itself;  a  discussion  ensued 
upon  the  subject,  and  several  cases  were  cited 
where  reflex  symptoms  were  cured  by  the 
removal  of  the  prepuce. 

A  communication  from  Dr.  Hillary,  of 
Ansto  Bay,  Jamaica,  was  then  read  regarding 
an  autopsy  in  which  air  was  found  in  the 
right  auricle  of  the  heart  and  in  the  gall 
bladfler,  and  there  was  also  general  emphysema; 
the  patient  had  died  suddenly. 

The  Society  then  adjourned. 


THE    PROVINCIAL    BOARD    OF 
HEALTH. 

The  first  general  meeting  of  the  newly-con 
stitated  Provincial  Board  of  Health  was  held 
in  this  city,  on  the  9th,  10th,  and  II th  ultimo. 
The  session  was  opened  in  the  Parliament 
Buildings,  under  the  Presidency  of  Dr.  Wm. 
Oldright,  Chairman  of  the  Board  ;  and  in  the 
first  day's  proceedings  all  of  the  members  of  the 
Board,  Rae,  Oshawa  ;  Yeomans,  Mount  For- 
est ;  Covernton,  Cassidy,  and  Hall,  Toronto  ; 
and  Bryce,  Secretary,  took  part.  After  the  read- 
ing of  the  Act,  creating  the  Board,  and  the 
Secretary's  commission,  the  subject  of  the 
epidemic  of  variola  at  Windsor  was  discussed  and 
action  taken  thereon,  after  which  the  Chairman 
delivered  his  inaugural  address,  which  will  be 
found  in  extenso  in  the  issue  of  the  Mail  news- 
paper for  the  12th  of  May.     A  communication 


was  received   from    Dr.  H.  B.  Baker,   the  Sec- 
retary of  the  Michigan  Board  of  Health,  on  the 
subject   of    immigrant   inspection,   urging   its 
necessity,  and   promising  the  earnest  co-opera- 
tion of  his  Board,  Dr.  Cassidy  presented  a  report 
of  the  proceedings  of  the  Sanitary  Convention 
lately  held  in   Greenville,  Michigan,  which  he 
and  Dr.  Oldright  attended  ;  and  Drs.  Covernton 
and  Yeomans  reported  their  investigation  into 
the  sanitary  condition  of  the  Town  of  Sarnia, 
and  the  conclusions  they  had  arrived  at  with 
reference  to  the  cause  of  the  recent  prevalence 
of  typhoid  fever  there.     After  passing  through 
Committee    of   the    Whole,    the    report    was 
adopted,  and  a  copy,  together  with  recommen- 
dations of  the  Board,  directed  to  be  forwarded 
to  the  Mayor  of  Sarnia.     A  circular  to  the  local 
municipalities,   anent     sanitary    reforms,  was 
drawn   up   and    3,000   copies   ordered    to    be 
printed  for  circulation.     Fifteen  hundred  copies 
of  certain  extracts  from  the  Statutes,  concern- 
ing public  health,    which    Dr.    Yeomans   had 
caused   to    be  drawn  up   were  ordered  to  be 
printed  for  circulation,  and  a  circular  to  medical 
practitioners  soliciting  their  co-operation  was 
determined   upon.      Dr.   Covernton    also    sub- 
mitted a  circular  to  medical  men,    requesting 
monthly  reports  of  cases  of  infectious  and  con- 
tagious diseases.     The  circular  was  referred  to 
a  special  committee  to  report  thereon  to  a  special 
meeting  on  the  1st  of  June.     The  Hon.  A.  S, 
Hardy,  Provincial  Secretary,  who  was  present 
on  the  second  day,  promised    to   have  2,000 
copies  of  the  Public  Health  Statutes  printed  for 
circulation.     Dr.    Covernton    introduced    the 
question   of  erecting   public  urinals,  and  also 
suggested   the   advisability    of   recommending 
to  municipalities  the  adoption  of  the  Rochdale 
system  for  closets.     The  necessity  for  a  special 
vehicle  in  cities  and  towns  for  the  conveyance 
to  hospital  of  infectious  cases,  and  of  a  strict 
surveillance  of  persons  and  things  in  contact 
with  such  cases  was  discussed.     Arrangements 
were   made   for    procuring   the  necessary   ex- 
changes of  sanitary  literature  for  the   Board, 
and  also  for  the  printing  of  3,000  copies  of  a 
digest,  approved  by   the  Attorney-General,  of 
Provincial   laws,  for  the  guidance  of  munici- 
palities, relative  to  the  powers  vested  in  them 
for  the  suppression  of  communicable  diseases. 


212 


CANADIAN  JOURNAL 


A  resolution  was  adopted  recomniending  muni- 
cipalities to  restrict  by  by-law  the  utilization  of 
made  ground  for  building  purposes  within 
certain  conditions.  On  motion  of  Dr.  Yeo- 
mans,  seconded  by  Dr.  Covernton,  the  Secretary 
was  instructed  to  procure  a  supply  of  reliable 
vaccine  for  the  use  of  practitioners ;  and  the 
project  of  securing  a  vaccine  establishment  in 
the  City  of  Toronto  was  considered.  After 
passing  votes  of  thanks  to  the  physicians,  in- 
habitants, and  Town  Council  of  Sarnia,  to  Dr. 
H.  B.  Baker,  Secretary  Board  of  Health,  of 
Michigan,  to  Mr.  Jno.  K.  Allen  and  Dr.  Nichol- 
son, of  the  Secretary's  Department,  and  to  the 
members  and  officials  of  the  Michigan  Board, 
to  the  officials  of  the  Detroit  Boar  d,  to  mem- 
bers and  ex-members  of  the  Toledo  Board,  to 
the  Mayor,  Dr.  Shelden,  Dr.  Avery,  and  other 
citizens  of  Greenville,  Mich.,  for  various  cour- 
tesies and  co-operation,  the  Board  adjourned. 


HURON  MEDICAL  ASSOCIATION. 

The  regular  meeting  of  the  Huron  Medical 
Association  was  held  in  Clinton,  on  Tuesday, 
April  4th,  Dr.  Holmes,  president  in  the  chair. 
The  following  members  were  present.  Drs. 
W.  J.  B.  Holmes,  Worthington,  Gillies,  Mc- 
Lean, McDonagh,  Williams,  McMicking,  Dun- 
can, Graham,  Scott,  Hurlburt,  and  Stewart. 

Dr.  Duncan,  of  Seaforth,  exhibited  another 
well-marked  example  of  Jacksonian  Epilepsy. 
The  patient,  a  female  child,  aged  38  months, 
enjoyed  good  health  until  she  was  11  months 
old,  when  the  present  difficulty  commenced 
suddenly  with  convulsions,  confined  to  the 
right  arm,  leg,  and  right  side  of  the  face,  which 
lasted,  it  is  said,  six  hours,  and  was  followed 
by  paralysis  of  the  convulsed  parts  of  some 
weeks'  duration.  From  this  time  up  to  the 
child's  second  year,  no  regular  fits  occurred, 
but  soon  afterwards  they  were  very  marked, 
and  when  severe,  the  left  side  was  slightly 
affected,  but  it  was  never  paralyzed  like  the 
right  side.  Speech  was  confused  and  inco- 
herent after  the  attacks.  For  several  months 
the  attacks  only  occurred  once  a  month. 
During  last  October  they  became  very  frequent, 
as  many,  sometimes,  as  14  in  one  day.  Since 
then  she  has  been  taking  bromide  of  potassium, 


and  now  they  only  happen  once   in  the  six 

weeks. 

During  the  attacks,  the  head  is  drawn  to  the 
right  side  and  the  eyes  to  the  loft.  When  the 
child  awakens,  her  right  extremities  are  found 
to  be  paralyzed.  The  paralysis,  however,  lasts 
but  a  few  hours,  as  a  rule.  The  child  is  often 
fretful,  and  when  gentle  pressure  is  made  on 
the  left  ear  she  is  soothed.  Memory  and  in- 
telligence good.  Patient  formerly  appeared  to 
be  conscious  during  the  attacks,  but  lately  she 
has  not  been  so. 

Family  History.  Unimportant  on  the 
father's  side,  but  on  the  mother's  side  her 
grandfather  was  subject  to  epilepsy,  and  her 
brother  died  in  a  fit,  and  his  youngest  daughter 
was  also  epileptic. 

Dr.  Graham,  of  Brussels,  showed  a  woman, 
aged  49,  who  has  Dupuytren's  contraction  of 
the  little  and  ring  fingers  of  both  hands. 

Dr.  Gillies,  of  Teeswater,  showed  a  well 
marked  example  of  infiltrating  carcinoma  of 
the  right  breast  and  axillary  glands,  with 
secondary  deposits  in  the  pleura,  in  a  woman 
aged  47. 

Drs.  Stewart  and  Hut  Iburt,  of  Brucefield, 
showed  patient,  aged  3^  years,  with  left  hemi- 
plegia following  unilateral  (left)  convulsions. 
The  child,  who  was  convalescing  from  scarlet 
fever,  was  seized,  on  the  14th  of  January  last, 
with  convulsive  movements  of  the  left  arm,  leg, 
and  face,  which  lasted  for  eight  hours.  On  the 
following  day  (Jan.  15)  the  child  was  still  un- 
conscious, with  a  pulse  of  140,  and  a  tempera- 
ture of  1 04°,  but  there  was  no  return  of  the 
fits.  On  the  16th  of  January,  the  left  arm 
and  leg  were  found  to  be  completely  paralyzed, 
in  which  condition  they  remained  for  a  week. 
Since,  there  has  been  a  gradual  improvement, 
but  the  child  still  drags  his  left  leg.  The  left 
arm  has  almost  completely  recovered  with  the 
exception  of  some  of  the  complex  hand  move- 
ments. The  urine  never  contained  any  albu- 
men, nor  was  there  discovered  at  any  time  any 
deficiency  in  the  quantity  of  urea. 

It  is  probable  that  both  the  convulsions  and 
paralysis  in  this  case  were  brought  about  by  a 
meningeal  haemorrhage. 

« ^♦^» 

The  last  issue  of  the  New  York  Med.  Record 
contains  a  recantation  of  its  heresy  on  Homoeo- 
pathic Consultations. 


OP  MEDICAL  SCIENCE. 


213 


"SUmWmtm^, 


BoRAcic  Acid  for  Granular  Lids. — Dr. 
James  L.  Minor  applies  the  pulverized  acid 
freely  to  the  everted  lids  with  a  brush, 
lachrymation  is  at  first  increased,  and  some 
pain  is  caused.  There  is  slow  and  steady 
amelioration  of  the  symptoms. —  Virginia  Medi- 
cal Monthly. 


A  Large  Brain. — The  case  is  recorded  by 
Chr.  Tompkins,  of  Richmond,  of  an  insane 
negro  whose  brain  weighed  72  ounces.  He 
was  32  years  of  age,  6  feet  2  inches  in  height. 
Had  committed  murder  twice,  was  twice  an 
inmate  of  a  lunatic  asylum,  and  was  generally 
considered  stupid. 

Stirling  on  Eucalyptus-oil  in  Lumbago. — 
Mr.  B.  A.  Stirling,  in  the  Lancet,  Dec.  1881, 
p.  1,155,  speaks  highly  of  the  value  cf  euca- 
lyptus-oil in  lumbago.  Mr.  Stirling  believes 
that,  by  the  free  inunction  of  this  agent,  he 
has  also  often  cut  short  a  bronchial  attack. 
The  formula  advised  is,  equal  parts  of  the  oil 
of  commerce,  olive-oil,  and  belladonna  liniment. 

Toronto  '  Telegram  '  *  Tattlb.' — 

How  doth  the  gentle  peeler  march 

Along  his  gentle  beat  ; 
How  inwardly  he  wishes,  for 

A  student  on  the  street. 

He  softly  smiles,  and  grins  with  glee. 
And  both  his  hands  doth  rub  ; 

He  fondles  with  an  easy  grace, 
His  student-bursting  club. 

"  Studentiana." — Dr.  Wattt. 

"  The  Old  World  motto  is  noblesse  oblige. 
Our  generous  men  of  wealth  are  changing  the 
phrase  to  richesse  oblige,  and  thus  becoming 
recognized  as  our  untitled  nobility.  It  is  only 
necessary  to  show  them  in  what  way  their 
beneficence  will  do  the  most  extendei  and  the 
most  lasting  good.  The  founding  of  five  or  six 
professorships  will  carry  the  names  of  their 
founders  down  to  a  remote  posterity,  and  call 
them  to  honored  remembrance  when  the  stately 
buildings  around  us  are  replaced  by  other  and 
still  nobler  structures." — Cincinnati  Med, News. 


Telephonic  Troubles. — Mistakes  may  hap- 
pen even  in  the  best  regulated  families.  Here 
is  an  example.  Chicago  is  blessed  with  a 
druggist  of  great  experience,  and  staid,  modest 
habits  of  demeanor.  It  is  his  custom  to  re- 
plenish his  stock  when  necessary,  by  ordering 
by  telephone  from  other  houses  in  the  same 
line  of  business.  With  this  purpose  in  view 
he  called  up  such  a  house,  and  supposed  he 
had  it,  when  in  fact  he  was  still  speaking  to 
the  telephone  office.  He  was  overwhelmed 
with  chagrin  and  shame  when  in  reply  to  his 
question,  "Have  you  large  black  nipples?" 
only  a  hearty  soprano  cachinnation  was  re- 
turned from  the  female  operator  in  the  office. 
For  a  number  of  days  thereafter  he  was  com- 
pelled to  repeat  his  blushes  as  he  caught  the 
lady's  laughter  whenever  she  heard  the  tones 
of  his  voice  on  the  wire. 

Medical  Colleges. — In  a  letter  published  in 
a  recent  issue  of  the  Boston  Medical  and  Surgical 
Journal,  Dr.  Oliver  Wendell  Holmes  writes  : 
"  A  school  which  depends  for  its  existence  upon 
the  number  of  its  students  cannot  be  expected  to 
commit  suicide  in  order  to  satisfy  an  ideal 
demand  for  perfection.  Any  institution  which 
is  essentially  dependent  on  the  number  of  paying 
students  it  can  draw  must  be  tempted  to 
sacrifice  its  higher  aims  to  popularity.  No 
high  standard  can  be  reached  under  such  cir- 
cumstances, and  the  only  way  to  insure  the 
independent  action  of  a  school  which  aims  at 
teaching  the  whole  country  by  example,  is  to 
endow  its  professorships,  so  that  the  very  best 
and  highest  grade  of  instruction,  and  not  that 
which  is  popular  because  it  is  easy  and  super- 
ficial, may  always  be  given  from  its  chairs, 
whether  the  classes  be  large  or  small.  A  small 
number  of  thoroughly  accoaiplished  medical 
graduates,  their  knowledge  based  on  sound 
scientific  acquirements,  and  made  practical  by 
assiduous  clinical  observation  and  teaching* 
will  be  worth  more  to  the  country  than  twice 
or  thrice  the  number  of  half-taught,  hastily- 
taught  practitioners.  A  series  of  such  classes 
will,  in  the  course  of  a  single  generation,  elevate 
the  whole  professional  standard,  as  they  go 
forth,  year  after  year,  missionaries  in  the  cause 
of  health. 


?u 


CANADIAN  JOURNAL  01?^  MEDICAL  SCIENCE. 


THE   NEW   CODE— DR.    BALDWIN   TO 
DR.  SAYRE. 

I  will  not  say  that  the  science  of  medicine  has 
never  been  promoted  by  any  ot  these  false 
systems.  Hydropathy  has,  perhaps,  taught  us 
something  of  the  virtues  and  abuses  of  cold 
water.  To  Thompsonianism,  as  once  practiced 
by  bold  and  crazy  empirics,  we  are  indebted 
for  a  fuller  knowledge  of  the  dangers  of  steam 
and  over-stimulation,  no  less  than  for  a  clearer 
iisight  into  the  mischievous  use  of  remedies 
in  themselves  innocent  or  even  valuable  when 
rightly  employed.  The  folly  of  Sir  Kenelm 
Digby  and  Lord  Gillbourne  in  the  use  of  the 
"  Sympathetic  Powder "  and  the  "  Weapon 
Salve"  in  the  treatment  of  recent  wounds, 
dates  the  correct  appreciation  of  union  by  the 
first  intention,  and  led  John  Hunter  to  com- 
prehend the  doctrine  of  adhesion.  The  cure  of 
scrofula  by  the  "  Royal  Touch,"  The  doctrine 
of  '•  Signatures  "  and  "  Perkinism  or  Metallic 
Tractors "  instructs  us  in  the  power  of  the 
magination  over  diseases.  Nor  can  I  doubt 
that  "  Homoeopathy,"  with  its  help  from 
"  expectant  attention "  and  the  farther  aid 
from  rigid  dieting  as  taught  by  Brousjais  and 
his  disciples,  has  made  us  better  acquainted 
with  the  curative  energies  of  nature  when  un- 
assisted by  medicine  And  I  can  see,  too,  how 
*'  charms"  and  "  amulets"  or  any  other  sort  of 
hocus-pocus  should  produce  results  similar  to 
those  claimed  for  Homoeopathy ;  and  in  the 
same  light,  I  can  comprehend  why  the  fond 
mother  still  hangs  the  coral  around  the  neck  of 
her  helpless  babe,  unconscious  of  the  medical 
teaching  which  originated  the  custom — just  as 
I  can  understand  how  the  Druids  of  ancient 
Britain  gave  virtues  to  the  mistletoe  by  cutting 
it  with  a  golden  knife  when  the  moon  was  six 
days  old,  as  their  voices  resounded  throuj^h 
the  groves  to  the  mystic  chorus  of  Derrydown  ! 
All  these  things  I  can  see  and  not  be  much 
the  wiser  for  seeing.  But  I  confess  my  utter 
inability  to  see  how  the  "  demands  of 
humanity  "  or  the  "  interest  of  a  liberal  pro- 
fession "  can  be  promoted  by  the  "  advanced 
idea "  of  consultation  between  a  regular 
practitioner  and  the  advocate  of  an   exclusive 


dogma,  even  though  the  latter  be  a  "  legaUy 
qualified  practitioner." 

But,  my  dear  Doctor,  we  need  not  repine  at 
these  things.  Great  sciences,  as  well  as  great 
principles  in  other  departments  of  life,  must 
be  subject  to  severe  trials.  By  detraction 
without,  by  dissension  within,  they  can  only 
be  tested.  Neither  form  of  trial  is  worth 
much  without  the  other,  and  it  is  when  they 
combine  in  the  history  of  a  profession  that 
such  a  profession  demonstrates  its  strength  and 
grandeur.  Just  now  our  profession  confronts 
one  of  these  hazards,  and  yet  I  cannot  but 
hope  that  the  new  code  of  Ethics  will  share 
the  fate  of  other  errors  that  have  sprung  up 
around  the  great  science  of  medicine,  to  live  a 
day  and  perish  forever.  Especially  do  I  hope 
that  New  York  will  yet  rise  in  her  majesty 
and  scourge  from  lier  temple  those  money 
changers  who  with  impious  hands  would 
destroy  the  sacred  instrument,  our  covenant, 
our  creed,  the  decalogue  of  our  profession  ; 
and  that  those  false  teachers  who  lately 
gathered  about  Albany  will  be  amazed  and 
appalled  at  their  own  folly  and  presumption 
when  the  ides  of  June  will  startle  them  with 
the  rebuke  which  awaits  them  from  St.  Paul. 
•'Money  changers  "  will  be  taken,  of  course, 
in  a  Pickwickian  sense,  since  the  gentlemen 
wh(j  have  leaped  to  the  front  of  philanthropy 
with  "advanced  ideas"  in  advocating  the 
"demands  of  humanity"  and  the  "interest  of 
a  liberal  profession"  could  never  think  of 
accepting  a  fee  for  such  consultation  !  It  may 
do  for  Brutus  t )  talk  to  Cassius  about  "  an 
itching  palm,"  but  in  our  days — the  days  of 
the  "  demands  of  humanity  " — it  must  be  ac- 
cepted as  a  mere  play  of  rhetoric. 

I  am,  my  dear  Doctor, 

Very  truly  and  sincerely  your  friend, 

W.  O.  Baldwin,  M.D. 
— American  Med.  Weekly. 


^itm,  '^rnlHt^,  m&  §am. 


DEATH. 


At  his  residence,  Beaverton,  on  May  15,  Alex.  Mc- 
Kay, M.D.,  eldest  son  of  the  late  James  McKay, 
township  of  Finch,  county  of  Stormont. 


THE 


:..'> 


A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


U.  OGDEN,  M.D., 

R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond 


}  CmmcUing  Editors.     I         *'  ""  BRIGHT,  B.A.,  M.B.,  M.R.C.S..  Enfl., )  ^^,.j,„ 
,, )  I         I.  H.  CAMERON,  M.B.,  > 


8UB8CRIPTIOIV,   $3    PER    AIVNUin. 


XS"  All  literary  oommanloations  and  Sxchanges  should  be  addressed  to  Dr.  OAMXBON,  273  SherboTime  St. ; 

or,  Dr.  WRIGHT,  313  Jarvis  St. 
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31  and  33  King  Street,  Toronto. 


TORONTO,  JULY,  1882. 


NOTES  ON  THEEAPEUTICS. 

BY  R.  L.  MACDONELL,   B.A,,  M.D.,  M.R.C.S.,  ENG. 

(Assistant  Demonstrator  of  Anatomy,   McGill  Univer- 
sity, Montreal,  Physician  to  Montreal  Dispensary.) 

THE  ERUPTIONS  CAUSED  BY  QUININE. 

Some  months  ago  Yan  Harlingen  published 
in  the  Archives  of  Dermatology,  an  elaborate 
account  of  all  the  medicinal  eruptions.  Five 
distinct  eflfects  in  the  skin  are  produced  by 
quinine  and  the  cinchona  compounds.  1.  Ery- 
thematous, or  scarlatiniform  eruption.  2. 
Papular.  3.  Urticaria.  4.  Purpuric.  5.  Ir- 
ritation of  the  skin  of  the  genitals.  Of  these 
the  erythema  seems  to  be  the  one  most  fre- 
quently met  with,  and  from  several  late  articles 
upon  this  subject,  it  may  be  inferred  that  this 
phenomenon  depends  more  upon  idiosyncrasy 
of  the  patient  than  upon  the  large  dose  of  the 
drug.  The  following  case  resembles  an  ordin- 
ary attack  of  scarlatina.  Prof.  Kobner,  Berlin 
{Klinisch  Wochenshrift)^  prescribed  quinine  for 
a  man  who  was  siiffering  from  bronchitis.  In 
two  hours  he  had  a  violent  rigor,  a  feeling  of 
suffocation,  severe  headache,  nausea,  and  vomit- 
ing. Two  hours  later  another  short  rigor,  fol- 
lowed by  a  burning  sensation,  at  first  in  the 
head  and  then  all  over  the  body.  These  phe- 
nomena occured  about  8  p.m.  The  next  morn- 
ing there  was  fever,  an  itching  eruption  over 
the  whole  bo-iy,  difficulty  of  swallowing,  and 
dryness  of  the  throat.  The  eruption  was  of  a 
deep  red  tint,  disappearing  momentarily  on 
pressure.     Face  swollen,  conjunctiva  injected, 

•  The  Monthly  Review  of  Medicine  and  Pharmacy, 
March,  1882. 


nasal  mucous  membrane  dry.  There  were  large 
papules  upon  the  thighs  surrounded  by  healthy 
skin.  Pulse  108,  temperature  of  skin  elevated, 
respiration  calm,  tongue  slightly  tremulous, 
moist,  posterior  walls  of  the  pharynx  very  red 
and  injected,  rest  of  the  mouth  normal.  This 
certainly  looked  like  scarlatina,  but  previously 
to  this  time  the  patient  had  had  two  similar 
attacks  as  the  result  of  taking  quinine.  The 
eruption  was  considered  by  the  physicians  at- 
tending as  scarlatina,  and  was  each  time  fol- 
lowed by  desquamation. 

Dr.  Gilliam,  in  the  same  journal,  relates  how 
he  prescribed  quinine,  in  three  or  four  grain 
doses,  for  a  boy  about  15  years  old.  In  a  few 
hours  the  patient  was  found  with  intense  con- 
gestion of  the  conjunctiva,  oedema  of  the  face 
and  limbs,  and  a  bright  erythematous  eruption 
of  the  whole  surface  of  the  body,  and  complain- 
ing of  terrible  burning  and  itching.  Subse- 
quently the  adminstration  of  quinine  on  two 
occasions  produced  the  same  symptoms. 

CORYZA. 

Dr.  N.  Ffalliott,  writing  to  the  British  Medi- 
cal Journal  states,  that  coryza,  or  nasal  catarrh, 
may  be  cured  in  a  few  hours  if  taken  at  the 
onset,  or  at  most  twelve  hours  afterwards,  by 
the  inhalation  of  a  spray  of  sulphate  of  quinine. 
The  solution  used  may  be  made  by  dissolving 
four  grains  of  quinine  in  an  ounce  of  water, 
with  just  sufficient  dilute  sulphuric  acid  to  dis- 
solve it,  and  scenting  with  any  agreeable  per- 
fume. A  hand-ball  spray-producer  is  used,  and 
the  quinine  st  ould  be  tasted  in  the  back  of  the 
mouth.  Apart  from  the  possibility  of  quinine 
being  antiseptic  and  destroying  the  germs  which 
may  give  rise  to  this   condition,  supposing  the 


216 


CANADIAN  JOURNAL 


catarrh  to  be  the  result  of  sudden  change  of 
temperature,  the  action  of  quinine  in  contract- 
ing the  superficial  capillaries  tends  to  lessen 
secretion  and  afford  relief. 

The  Monthly  Review  of  Medicine  and  PJutr- 
macy  recommends  for  a  common  cold  five 
grains  of  quinine,  to  be  taken  as  soon  as  you 
begin  to  sneeze  and  suffer  from  a  feeling  of 
tightness  in  the  nasal  passages.  Repeat  the 
dose  every  six  hours,  till  three  doses  are  taken, 
and  you  will  soon  be  well  of  your  cold. 

The  remedies  for  colds  are  numerous,  as  was 
pointed  out  many  years  ago  by  Mark  Twain. 
There  is  nothing  like  personal  experience  in 
these  matters.  The  writer  of  these  lines  re- 
commends to  his  brethren  the  use  of  a  little, 
\  grain,  pill  of  sulphate  of  morphia  to  abort  a 
cold.  To  keep  down  coryza,  when  one  has 
business  to  attend  to,  there  is  scarcely  anything 
more  comforting  than  the  snuff  of  Dr.  Ferrier, 
(R.  Morphias  hydrochloratis,gr.  ii.;  pulv  acacise, 
5ij.  ;  bisncuthi  nitratis,  5vi. ;  M.  The  snuff) 
blown  well  up  the  nose  by  an  insufilator. 

NITRITE   OF    AMYL     IN   INFANTILE   CONVULSIONS. 

The  power  of  this  agent  in  allaying  mus- 
cular spasm  is  being  well  established.  A  writer 
in  the  Lancet,  (April  22nd),  1882,  Dr.  Bridger 
reports  success  with  it  in  the  treatment  of  con- 
vulsions in  children.  Case  1.  Convulsions  re- 
sulting from  an  abscess  in  tympanum.  One 
thii'd  of  a  minim  of  nitrite  of  amyl  in  mucilage 
was  directed  to  be  applied  to  the  child's  nostrils 
every  three  he  urs — the  amyl  floating  on  the 
mucilage.  In  the  first  twenty-four  hours  of 
this  treatment  there  was  but  one  convulsion, 
and  during  the  three  remaining  days  of  the 
child's  life  he  had  no  difficulty  in  keeping  those 
symptoms  under  control,  though  he  found  it 
necessary  to  increase  by  one-third  the  dose 
every  twenty-four  hours.  Case  2.  Patient  aged 
six.  Tubercular  meningitis  for  a  fortnight, 
and  for  two  or  three  days  almost  constant  con- 
vulsion. Nitrite  of  amyl  as  in  case  1.  Marked 
improvement ;  the  twitchings  almost  entirely 
ceased,  and  the  child  had  some  hours  of  sleep. 
Oases  3  and  4  were  aged  respectively  five  and 
nine  months,  and  the  convulsions  were  due  to 
dentition.  The  older  took  occasionally  one- 
fourth  of  a  drop  dissolved  in  spirit  and  given 


on  sugar,  according  to  Dr.  Ringer's  plan.     The 
treatment  succeeded. 

THE    RELIEF    OF    CATARRHAL  CONDITIONS  OF  THB 
NASAL    PASSAGES   BY    INSUFFLATION. 

The  Archives  of  Medicine,  April,  1882,  con- 
tains a  good  practical  paper  from  Dr.  Good- 
willie.  His  insufflator  is  the  best  yet  pro- 
duced, inasmuch  as  the  portion  to  be  inserted 
into  the  nostril  is  large  enough  to  close  up  that 
opening  and  prevent  the  escape  of  the  powder. 
The  instrument  he  uses  is  like  a  hydrogen  bot- 
tle, and  a  country  doctor  with  ten  cents  worth 
of  glass  and  a  little  ingenuity  will  be  able  to 
make  a  fair  substitute.  A  four  or  six  ounce 
wide-mouthed  bottle,  a  perforated  cork,  and  two 
pieces  of  bent  glass  tube  are  required.  The 
glass  tubes,  bent  at  right  angles,  are  fixed  in 
the  cork.  The  powder  is  put  into  the  bottle 
and  air  blown  into  the  opposite  tube.  Dr.  Good- 
willie's  apparatus  has  valves  in  the  cork  to 
prevent  return  of  the  powder,  and  the  air  is 
supplied,  as  in  Richardson's  apparatus  for  local 
anaesthesia  by  two  rubber  globes. 

The  powder  used  must  be  very  finely  tri- 
turated, and  when  blown  in  the  air  should  float 
like  smoke.  The  favourite  formulae  are  given. 
No.  1.  R  Benzoini,  7,j ;  raorphiae  muriatis,  gr. 
vi;  bismuthi  subnitratis,  potassii  nitratis  aa  5S8. 
This  is  very  much  like  the  snuff  elsewhere 
mentioned  and  is  said  to  be  useful  in  hyper- 
aemic  conditions  with  pain.  In  the  beginning 
of  an  attack  of  rhinitis  coat  the  mucous  surface 
with  it.  No.  2.  R  Aluminis,  3i ;  acaciae,  bis- 
muthi subnitratis,  potassii  nitratis  aa  "^vr. 
Useful  where  a  strong  astringent  is  required. 
In  case  of  haemorrhage  from  the  nose,  remove 
all  the  clot  and  immediately  blow  in  this  pow- 
der abundantly  until  the  bleeding  ceases.  R 
lodoformi,  camphorae,  aa  3j  J  bismuthi  sub- 
nitratis, potassii  nitrat.,  aS,  f,\.  ss.  Useful  as  an 
antiseptic  where  there  are  fcetid  discharges,  or 
where  ulceration  is  present,  or  an  excessive 
amount  of  granulations.  For  the  general  prac- 
titioner these  applications  are  vastly  more  con- 
venient than  sprays. 

THE    TREATMENT   OF   BUBO. 

With  reference  to  Dr.  Petersen's  plan  of 
treating  bubo,  referred  to  in  your  last,  I  do 
not   see   any   very   great    advantage    in    this 


OF  MEDICAL  SCIENCE. 


217 


method.  Pressure  is  the  active  therapeutic 
agent  in  this  as  well  as  in  other  antiseptic 
proceedures.  The  best  plan  of  treating  a  bubo, 
in  the  writer's  humble  opinion,  is  to  put  on  a 
pad  of  lint,  soaked  in  iced  lead  lotion,  and  over 
this  to  apply  a  firm  spica  bandage.  Should  pus 
form,  the  larger  the  opening  the  quicker  the 
cure.  I  think  that  in  this  way  I  have  seen 
better  results  than  those  of  Petersen. 

CHRYSOPHANIC   ACID    INTERNALLY. 

Chrysophanic  acid  is  the  best  and  most 
generally  serviceable  remedy  in  psoriasis. 
Prof.  Charteris,  by  a  simple  experiment,  proved 
that  its  action  is  general  as  well  as  local.  In 
cases  where  the  skin  was  diseased  on  both  legs, 
one  leg  was  treated  with  chrysophanic  ointment, 
the  eruption  disappeared  nearly  as  rapidly  from 
one  side  as  the  other.  Then  again  in  other  cases, 
constitutional  symptoms  were  produced  by  local 
applications,  and  nausea,  vomiting,  looseness  of 
the  bowels  were  noticed.  ^ 

Dr.  Napier,  Physician  for  Skin  Diseases  in  the 
Dispensary,  in  connection  with  Anderson's  Col- 
lege, Glasgow,  {Lancet,  May  20th,  1882),  has 
been  using  the  acid  internally  for  the  treat- 
ment of  psoriasis.  His  cases  are  as  follows  : 
Case  1.  Lad  aged  16.  After  having  had  the 
disease  five  months.  Nov.  2nd  :  Three  grains 
of  chrysophanic  acid  and  40  grains  of  sugar  of 
milk,  to  be  made  into  twenty  four  powders  ;  one 
powder  to  be  taken  after  each  meal.  Nov.  9  th  : 
Patches  much  paler,  less  scaly,  less  itchy.  Four 
grains  of  the  acid  in  24  powders  to  be  taken  as 
before.  No  vomiting  or  any  sign  of  gastric 
disturbance.  Nov.  23rd  :  Patches  paler,  less 
itchy.  Six  grains  in  24  powders.  Nov.  30th: 
Eight  grains  in  24  powders.  Dec.  7  th  ;  Ten 
grains  in  24  powders.  Dec.  21st :  Improve- 
ment very  marked,  twelve  grains  in  24  powders. 
On  the  25th  January  he  was  taking  48  grains 
in  24  powders.     Feb.  2nd  :  perfectly  well. 

Dr.  Napier  cites  two  other  cases,  but  this 
one  contains  the  instruction  necessary  for  one 
who  wishes  to  try  this  promising  treatment. 
By  using  this  drug  in  this  manner,  all  the  draw- 
backs to  its  use,  externally,  are  obviated,  and 
in  cases  where  a  large  surface  has  to  be  at- 
tacked there  will  be  a  great  saving  effected  in 
the  amount  of  acid  consumed  in  the  course  of 


the  treatment.  Dr.  Napier  suggests  \  grain  as 
a  good  medium  dose  to  start  with,  and  finds 
sugar  of  milk  the  best  excipient.  The  dose 
should  be  increased  up  to  the  limits  of  tolera- 
tion. One  of  Prof.  Charteris'  cases,  a  girl  13 
years  of  age,  takes  nine  grains  a  day. 


SOME  POINTS  OF  GENERAL  INTEREST 
IN  OPHTHALMOLOGY. 

(Paper  read  at  Meeting  of  Toronto  Medical  Society, 
May  18th,  1882.) 

BY    R.    A.    BE  EVE,'    B.A.,    M.D,, 

Lecturer  on  Diseases  of  the  Eye  and  Ear,  in  Toronto 

School  of  Medicine  ;  Oculist  and  Aurist  to 

Toronto  General  Hospital. 

(Continued  from  page  191. J 

KERATITIS — (COBNEITIS). 

In     the    commonly-occurring     phlyctenular 
keratitis,  a  sort  of  corneal  herpes  with  result- 
ing punctate  excoriations  or   superficial  ulcera- 
tion, met  with  principally  in  young  subjects  of 
strumous  habit,  with  the  characteristic  picture 
of  intense  photophobia,  profuse  lachrymation, 
and  spasm  of  the  orbicularis,  the  knowledge  of 
the  constitutional  predisposing  cause  and  the 
probable  persistence  of  the  trouble  until  the 
former  is  corrected  by  general  treatment  and 
hygiene,  and  possibly  the  eruption  of  teeth  is 
over,    has   fostered    a    tendency    to    let    the 
eyes  pretty  much  alone.      Much,  however,  can 
be  accomplished  by  local  applications,  while  the 
systemic  medication,  by  means  of  cod-liver  oil, 
syr.  ferri.  iod.,  maltine  and  hypophosphites,  syr. 
ferri.   phosph.    co.,    syr.    calcis    lactophosph., 
arsenic,    &c.,    is    carried    on,    and  a    proper 
regimen   enforced.      The   use   of  atropine   in 
strong  solutions,  (grs.   2 — 4  atropise  sulph.  ad. 
Ij.   aq.   dest.),  instilled  two  or  three  times  a 
day  causes  marked  relief  of  pain,  photophobia, 
spasm,  (fee,  and  is  unattended  by  toxic  effects, 
the  dread  of  which  seems  to  lead  many  to  dis- 
card  it  altogether  or  to  prescribe  solutions  so 
weak  as  to  be  of  little  value.      The  addition  of 
boracic  acid  grs.    x  . —  x  x   ad.  5j.  sol.   atropise 
is    of  great  service  when,  as  often  happens, 
catarrhal  conjunctivitis  accompanies  the  kera- 
titis.     Astringents  and  argent,    nit,,  so  com- 
monly resorted  to  on  the  supposition  that  the 
former  is  the  principal  affection,  are   contra- 


218 


CANADIAN  JOURNAL 


indicated  because  thej  generally  aggravate  the 
much  more  serious  corneal  inflammation,* 
When  the  acute  symptoms  have  subsided,  the 
standard  i-emedies  are  the  yellow  or  red 
oxide  of  mercury  in  the  form  of  ointment,  (gr, 
i-ij.  ad.  5j-  vaseline),  or  plasma  (gr.  i-ij.  ad.  3j- 
of  glycerinum  amyli.) ;  and  also  levigated  calo- 
mel, dusted  upon  the  cornea.  The  red  oxide 
must,  of  course,  be  very  thoroughly  triturated 
before  incorporation  and  the  calomel  well 
washed. 

Another  form  of  keratitis,  the  vascular, 
with  superficial  opacity  and  vascularity,  gener- 
ally of  the  upper  segment,  often  proves 
puzzlingly  obstinate  or  recurrent  because  the 
efficient  cause,  namely  chronic  conjunctivitis,  is 
not  detected  and  relieved.  It  is  important  in 
nearly  all  cases  of  corneal  inflammation  to  learn 
the  state  of  the  palpebral  conjunctiva.  It  is 
to  be  feared  cases  are  often  regarded  as  kera- 
titis, per  se,  the  lids,  though  as  rough  as  a  rasp- 
berry, never  being  everted. 

On  the  other  hand,  vigorous  treatment  of 
the  lids  should  be  deferred  until  pain,  photo- 
phobia and  lachrymation  have  been  relieved  by 
atropine,  &c.  Iritis,  which  is  a  not  infrequent 
result  and  complication  of  corneal  inflammation, 
may  be  readily  excited  if  the  present  irritability 
of  the  eye  be  increased  by  the  injudicious  or 
premature  use  of  cupri  sulph.  crystal,  argenti 
nit,  or  strong  astringent  collyria.  The  weak 
plasma  hydrarg.  ox.  rub.  vel.  flav.  is  a  useful 
adjunct,  for  home  application,  to  the  treatment 
required  for  the  conjunctivitis  proper. 

It  is  a  pity  to  have  to  note  that  one  form  of 
keratitis,  the  parenchymatous,  difi'use,  or  inter- 
stitial, is  on  the  increase  in  this  country, 
largely  by  importation,  however ;  occurring 
generally  in  the  subjects  of  hereditary  syphUis 
of  five  to  twenty-five  years  of  age  who  have 
the  characteristic  notched  or  corrugated  teeth, 
and  a  somewhat  significant  history  if  not  phy- 
siognomy ;  both  cornese  becoming  gradually 
more  or  less  opaque  with  finely  meshed  and 

*  Even  in  phlyctenular  and  pustular  conjunctivitis 
in  which,  as  a  rule,  pain,  photophobia,  &c.,  are  absent, 
astringents  have  to  be  used  with  caution,  boracic  acid 
wash,  with  a  little  atropia  or  morphia,  being  preferable 
in  the  acute  stage,  and  ungt.  or  plasm,  hydarg.  ox.  rub. 
or  flav.,  or  calomel,  hiter. 


deep-seated  vascularity,  but  without  ulceration ; 
reaching  the  acme  in  from  two  to  eight  weeks 
and  receding  in  as  many  months,  but  sometimes 
leaving  a  permanent  nebula  and  defective  sight. 
Here  again,  in  addition  to  proper  constitutional 
treatment  and  oft-repeated  hot  fomentations, 
systematic  atropine  instillations  are  required, 
so  as  to  prevent  or  combat  iritis,  which  is 
a  frequent  complication. 

In  ulcers  of  the  cornea,  which  are  more  or 
less  peripheral  and  unattended  by  iritis,  eserine 
(eserin  sulph.,  grs.  ij — iv,  acid  boracic,  grs. 
x-xx,  aq.  destgj.)  is  often  better  than  atroinne, 
an  additional  indication  being  a  tendency  to 
bulging  or  staphyloma  of  the  cornea,  and 
glaucoma.  It  is  especially  valuable,  con- 
joined with  support  by  compress  and  bandage, 
in  large  ulcers  which  weaken  the  cornea  and 
threaten  the  loss  of  the  eye,  such  as  sometimes 
occur  in  ophthalmia  neonatorum  and  gonor- 
rhoea! ophthalmia.  In  ulcers  with  iritis  or  great 
irritation,  especially  if  they  do  not  threaten  per- 
foration and  are  centrally  placed,  atropine  is 
preferable,  and  atropinized  oil  or  vaseline  is 
sometimes  better  thanthe  aqueous  solution.  In 
ulcers  with  hypopyon  an  iridectomy  maybe  neces- 
sary to  arrest  the  disease  ;  securing  also  what 
will  likely  be  required,  a  new  pupil.  It 
also  arrests  the  development  of  staphyloma 
and  glaucoma  where  eserin  has  failed.  In  cer- 
tain cases  of  progressive  or  "  creeping  "  ulcer 
an  incision  through  the  cornea  across  the  seat 
of  ulceration  proves  effective,  but  should  not  be 
tried  indiscriminately.  Corneal  ulceration 
generally  indicates,  as  elsewhere  observed,  the 
use  of  tonics  &c.,  and  a  supporting  regimen. 

CONJUNCTIVITIS. 

Trachoma  or  granular  conjunctivitis  may  be 
singled  out  as  the  bane  of  ophthalmic  practice, 
because  of  its  chronicity,  the  persistent  charac- 
ter of  the  small  lymphomata  which  stud  the 
conjunctiva  ;  the  secondary  keratitis  or  ulcera- 
tion with  resulting  opacity  and  impairment  or 
loss  of  sight,  and  the  permanent  changes  in  the 
lid,  causing  entropion,  or  a  bevelling  oflf  of  the 
inner  lip  of  the  lid  with  mal-position  of  the 
eyelashes  (trichiasis),  which  in  turn  causes 
irritation  of  the  eye,  if  not  inflammation  of  the 
cornea ;  to  which  also  epiphora  from  interfer- 


OF  MEDICAL  SCIENCE, 


219 


ence  with  the  puncta,  &c.,  adds  its  quota  of 
discomfort.  In  chronic  conjunctivitis,  which 
is  much  more  common  than  is  suspected,  the 
affected  membrane  presents  generally  hyper- 
trophied  papillae  as  well  as  enlarged  follicles, 
together  with  some  sub-conjunctival  infiltra- 
tion. The  main  indication  in  the  treatment  is 
moderate,  systematic  stimulation  by  topical 
applications  to  the  everted  lids  persistently 
carried  out  so  long  as  any  follicles,  or  con- 
junctival hypertrophy  remain,  i.e.,  until  the 
palpebral  surfaces  become  pale  and  smooth.  Two 
months  rarely  suffice  to  effect  this,  and  a  year 
or  more  may  be  required,  disheartening  re- 
lapses being  too  easily  provoked  by  slightly  ex- 
citing causes. 

Electricity  is  of  some  value  as  a  stimulant, 
and  I  have  found  galvano-puncture  a  com- 
paratively painless  and  efficient  means  of  dis- 
cussing the  obstinate  grain-like  follicles  ;  but 
the  standard  remedies  with  which  we  are  all 
familiar,  are  : — Cupri  sulph.,  crystal,  argent, 
nit.,  in  solution,  gr.  x,  ad  xx,  ad  gj  aq,  or  in 
points  diluted,  to  33  or  50  per  cent,  strength 
with  potassse  nit.  ;  the  yellow  or  red  oxide  of 
mercury  ointment  8-24  gr.  ad  §j,  and  glycerole 
of  tannin  (gr.  20-60  ad  §j  glycerine,)  with 
astringent  compresses,lotions  &c.;  and,  of  course, 
appropriate  general  treatment.  The  latter  is 
especially  indicated  where  the  cornea  is  in- 
volved, and  should  be  tonic  in  the  broadest 
sense. 

Purulent  conjunctivitis  is  of  recognized 
gravity  owing  to  the  danger  of  corneal 
ulceration,  and  an  effort  is  now  being 
made  to  diminish  the  virulence  and  lessen 
the  occurrence  of  the  most  common  variety, 
that  of  new-born  infants,  by  antiseptic  or  anti- 
specific  treatment  of  the  vagina  before  parturi- 
tion. It  would  be  a  wise  routine  practice  for 
the  accoucheur  to  daily  inspect  the  infant's  eyes 
during  his  after  attendance,  and  if  there  has 
been  any  antecedent  vaginal  discharge,  to  have 
the  eyes  washed  immediately  after  birth  with 
solution  acid  boracic,  and  several  times  a  day 
for  a  few  days. 

Some  authorities  go  so  far  as  to  say  that  loss 
of  the  eye  from  ulceration  of  the  cornea  in 
ophthalmia  neonatorum  is  an  evidence  of  mal- 
practice, but  the  tenable  position  is  that  nearly 


all    cases    should     recover     without    corneal 
damage. 

In  ophthalmia  neonatorum  the  following 
line  of  treatment  is  almost  uniformly  suc- 
cessful :  the  faithful  application  of  cold  or 
ice-water  dressings  and  frequent  irrigation 
of  the  conjunctival  sac  with  a  saturated 
solution  of  boracic  acid,  i.e.,  gre.  xx,  ad 
5J  aq.  (to  which  zinci  sulph.  may  be  added  in 
the  proportion  of  gr.  ss.  to  i.  ad  gj) ;  and  the 
instillation  every  four  or  six  hours  of  a  few 
drops  of  a  half  per  cent,  solution  of  argenti  nit. 
The  following  collyria  are  valuable,  and  are 
relied  upon  by  some:  zinci  chlorid  and  morphia 
hydrochlor.  aa,  gr.  ij,  ad  gj  aq.  destill,  alum  grs. 
v-x,  ad  Ij  aq.,  and  carbolic  acid  in  one  or  even 
two  per  cent,  solutions.  In  severe  cases,  likely 
due  to  specific  contagion,  it  may  be  necessary 
to  -ipply  daily  to  the  everted  lids  sol.  argenti 
nit.  grs.  X,  ad  gj  aq.,  or  the  diluted  silver 
points,  followed  by  weak  salt  water.  And  if 
the  cornea  become  involved,  atropine  or  eserin 
may  be  required  as  already  indicated. 

That  most  virulent  form  of  purulent  con- 
junctivitis, the  gonorrhoeal,  would  undoubtedly 
be  of  less  Irequent  occurrence  were  ])lain  and 
impressive  statements  as  to  the  danger  and 
results  of  inoculating  the  conjunctiva  made  to 
all  subjects  of  specific  urethritis  when  beginning 
treatment. 

The  importance  of  another  precaution  should 
also  be  emphasized,  namely,  the  sealing  up  of 
the  sound  eye  so  as  to  prevent  inoculation  from 
its  fellow,  a  mishap  not  unlikely  to  occur. 
This  can  be  effected  by  a  curtain  of  gutta 
percha  tissue  fastened  by  rubber  plaster  and 
flexible  collodion  to  brow  and  nose,  or  BuUer's 
shield  of  rubber  cloth  with  watch-glass  set  in 
the  middle.  The  old-time  general  depletion 
and  salivation  have  been  discarded,  and  quinine 
in  good  doses,  and  nutritious  diet  are  often 
found  useful.  Rest  in  bed,  ice- water  dressings, 
very  frequent  irrigations  of  the  conjunctival 
sac  with  sol.  acid,  boracic,  or  of  boracic  acid  and 
zinc,  and  the  application  once  a  day,  or  morn- 
ing and  evening,  of  a  ten  grain  solution  of 
argent,  nit.,  or  once  a  day  of  the  diluted  silver 
points,  with  occasional  light  scarifications,  and 
atropine  or  eserin  as  may  be  indicated,  con- 
stitute the  most  reliable  treatment  during  the 


220 


CANADIAN  JOURNAL 


active  btage.  Dividing  the  outer  caiithus 
effects  both  local  depletion  and  relief  of  danger- 
ous pressure  upon  the  cornea,  and  is  often  a 
valuable  exj>edient.  In  sthenic  subjects,  de- 
pletion from  the  temple  by  leeching  or  cupping, 
practised  early  in  the  congestive  stage,  tends  to 
relieve  pain  and  mitigate  the  severity  of  the 
attack. 

One  word  as  to  hygiene  in  conjunctival 
diseases,  which,  as  a  rule,  are  contagious. 
Greater  precautions  should  be  taken  than  are 
now  in  vogue  to  prevent  their  spread.  All 
ways  of  transferring  contagion,  by  towels, 
basins,  handkerchiefs,  pillow-cases,  etc.,  should 
be  provided  against ;  and  isolation  or  quaran- 
tining in  public  institutions,  and  the  careful 
ventilation,  etc.  of  dormitories  should  be  in- 
sisted on. 

Diphtheritic  conjunctivitis  is  mentioned, 
merely  to  draw  attention  to  the  interesting  fact 
of  its  extreme  rarity  in  this  country,  where, 
unfortunately,  diphtheria  proper  is  not  un- 
common. And  again,  the  infrequent  mem- 
branous or  croupous  variety,  in  which  there  is 
a  superficial  and  adherent  plastic  exudation,  is, 
I  opine,  less  often  of  distinctive  origin  than  the 
result  of  too  early  use  of  caustics  or  strong 
astringents  in  cases  of  purulent  or  catarrhal 
conjunctivitis. 

IRITIS. 

The  prompt  recognition  and  proper  treat- 
ment of  iritis  are,  happily,  becoming  mort  com- 
mon, but  I  fear  its  gravity  is  not  yet  duly 
estimated,  and  too  little  heed  is  paid  to  a 
disease  which  not  seldom  entails  the  life-long 
disability  of  impaired  sight,  abnormal  sensitive- 
ness to  exciting  causes,  with  tendency  to  re- 
lapses, and  also  to  other  morbid  processes,  as 
glaucoma,  cataract,  choroiditis,  sympathetic 
ophthalmia,  etc.  The  old-time  diaj^rams  of  the 
eyeball,  showing  the  lens  at  some  distance  be- 
hind the  plane  of  the  iris,  are  quite  misleading. 
Were  they  true  to  nature  the  dreaded  ad- 
hesions could  hardly  occur.  The  fact  is,  the 
central  part  of  the  iris  is  practically  in  contact 
with  the  lens  capsule,  and  hence  the  facility 
with  which  the  two  become  glued  together  by 
lymph,  and  also  the  area  of  the  pupil  invaded 
thereby.  It  is  advisable  to  be  always  on  the 
alert  for  iritis,  as  it  is  of  common  occurrence. 


either  idiopathicaily,  or  traumatical ly,  or  second- 
arily to  inflammation  and  ulceration  of  the 
cornea;  is  due  to  syphilis  in  from  60  to  70 
[)er  cent.,  sometimes  to  rheumatism,  occasionally 
to  gonorrhoea,  and  is  also  of  sympathetic 
origin. 

Fortunately,  its  diagnosis  is  comparatively 
easy  :  a  rosy  circum-corneal  zone  of  injected 
vessels,  finely  meshed  and  lying  beneath  the 
larger,  duller,  and  movable  conjunctival  set;  a 
dull  or  discolored  iris,  contracted,  sluggish,  or 
immobile  pupil ;  more  or  less  photophobia, 
lachrymation,  and  dimness  of  sight,  with  reflex 
neurosis,  the  pain  being  most  severe,  or  possibly 
only  present,  at  night.  Nocturnal  pain  or  ex- 
acerbations in  and  radiating  from  the  eye  should 
at  once  arouse  a  suspicion  of  iritis.  Sometimes 
the  greatest  distress  is  felt  on  the  top  of  the 
head,  and,  indeed,  towards  the  occiput,  the  seat 
of  distribution  of  the  pericranial  and  cutaneous 
filaments  of  the  supraorbital  nerve.  Oc- 
casionally, this  so-called  neuralgia  is  so  severe 
that  it  is  mistakenly  thought  to  be  the  cause 
instead  of  the  effect  of  the  eye  trouble,  and  it 
is  often  present  in  specific  cases,  though  the 
contrary  opinion  seems  to  be  held  by  some. 
Again,  iritis  is  sometimes  confounded  with 
conjunctivitis,  with  a  premature  resort  to  astrin- 
gents, et  al.  which,  of  course,  aggravate  the 
mischief.  The  differential  diagnosis  is  generally 
easily  made : — The  congestion  of  iritis  is  cir- 
cumcorneal  and  ocular,  attended  by  lachryma- 
tion, not  blennorrhcea  ;  that  of  conjunctivitis  is 
mainly  palpebral  and  in  the  cul-de-sac,  and  is  soon 
followed  by  the  hyper-secretion  of  mucus,  muco- 
pus,  etc.,  while  the  pupil  is  generally  active 
and  the  iris  bright,  and  the  vision  unaffected, 
or  not  dimmed,  save  by  passing  shreds  of 
mucus,  etc. 

I  would  urge  the  propriety,  where  any  un- 
certainty exists,  of  using  atropine,  and  not 
astringents ;  a  plowly  dilating  or  irregular 
pupil  will  give  the  desired  clue.  It  will  bear 
iteration  that  the  main  point  in  treatment  is  to 
secure  and  maintain  throughout  the  fullest 
dilatation  of  the  pupil.    This  often  requires  from 

3  to  16  or    20  instillations  in  the  24  hours,  of  a 

4  gr.,  or  1  per  cent,  'solution  of  atropise  sulph. 
The  sooner  resorted  to  the  less  required.  In 
few  instances  does  a  remedy  so  fully  meet  the 


OF  MEDICAL  SCIENCE. 


221 


indications  as  does  atropine  in  iritis.  It 
secures  rest  (to  iris,  ciliary  body,  and  lens),  and, 
largely,  relief  from  pain,  and  also  reduces  the 
area  of  the  inflamed  tissue  and  the  calibre  of 
its  vessels,  and,  therefore,  the  amount  of  exuda- 
tion and  damage,  to  the  minimum;  and  removes 
the  iris  as  far  as  may  be  from  the  lens.  A  fully 
dilated  pupil  is  one  whose  area  is  nearly  equal 
to  that  of  the  cornea. 

In  addition  to  the  vigorous  use  of  atro- 
pine, the  principal  points  to  be  observed  are, 
disuse  of  both  eyes  and  their  protection  from 
light ;  frequent  hot  fomentations,  and  cupping 
or  leeching  at  the  temple,  repeated  in  twenty- 
four  or  thirty-six  hours,  and  possibly,  a  few 
times  at  intervals  of  three  or  four  days ;  paint- 
ing the  forehead  with  oleate  of  mercury,  having 
gr.  j,-ij  of  morphia  and  gr.  ss-j  of  atropia,  (the 
alkaloids),  ad  5j  ;  pil.  opii.  or  hypodermics  of 
morphia,  p.r.n.  to  relieve  pain;  ard,  of  course, 
appropriate  constitutional  treatment.  "Where 
there  is  much  exudation  or  imperfect  dila- 
tation of  the  pupil,  or  a  tendency  to  cbronicity, 
a  mild  mercurial  course  is  valuable  even  in 
non-specific  cases.  In  specific  cases  the  free 
use  of  oleate  of  mercury  is  a  good  adjunct  to 
other  medication  and  a  cleanly  substitute  for 
ungt.  hydrarg ;  the  latter  being  preferable 
where  a  speedy,  decided  effect  is  desired,  and 
the  deeper  structures  are  involved.  And  in 
cases  of  chronic  or  recurrent  iritis,  where  the 
pupil  is  invaded,  and  its  margin  adherent,  in 
whole,  or  great  part  to  the  lens  capsule,  an 
iridectomy  is  generally  indicated.  A  timely 
resort  to  it  sometimes  prevents  deep-seated  and 
irreparable  mischief. 

{To  he  concltided.) 


A  CASE  OF  ACUTE  PHTHISIS. 

BY   J.    FERGUSON,    B.A.,    M.B.,    L.R.C.P.,     <fec., 

Assistant  Demonstrator  of  Aijatomy,  Toronto  School 
of  Medicine. 

M.  B.  L.,  aged  29,  began  to  complain  of 
sore  throat  about  the  middle  of  December, 
1881.  In  the  early  part  of  January,  1882,  she 
began  coughing  a  good  deal,  and  her  voice  be- 
came very  husky  and  low.  At  this  stage 
of  her  trouble  one  of  her  children  took  ill  with 
scarlet  fever,  and  required  considerable  atten- 
tion. This  was  too  much  for  the  mother,  whose 


health  now  began  to  go  down  very  rapidly. 
Night  sweats  came  on  and  were  very  profuse, 
and  the  temperature  was  102  F.  The  pulse  was 
less  than  101  per  minute.  Debility  increased 
rapidly.  Pulmonary  signs  were  well  marked. 
Dr.  H.  H.  Wright,  who  saw  the  patient,  de- 
clared it  to  be  a  case  of  phthisis.  About  the 
last  days  in  February  she  took  to  her  bed  and 
became  extremely  weak,  so  much  so  that  she  could 
not  raise  her  head  without  assistance,  and  was 
afflicted  greatly  with  dyspnoea.  Early  in  March 
the  temperature  rose  to  103  F.  and  the  pulse 
generally ^about  130,  while  vomiting,  and  diar- 
rhoea became  excessive.  As  the  patient  could 
not  lie  on  her  left  side  so  as  to  relieve  the  right 
a  large  bed-sore  formed  over  her  right  shoulder, 
and  one  threatened  to  appear  on  the  right  hip. 
By  the  middle  of  March  the  cough  was  very 
severe  and  the  throat  became  intensely  sore, 
so  that  as  much  as  two  hours  were  required  to 
swallow  a  cupful  of  warm  milk.  The  voice  was 
low  and  completely  gone,  and  the  patient  could 
only  speak  in  feeble  whispers.  About  this  time 
her  feet  and  legs  began  to  pain  her,  and  soon 
the  pain  became  so  great  that  the  bed  clothes 
could  not  be  borne. 

The  above  is  a  brief  statement  of  the  case.  I 
shall  give  the  treatment  which  was  adopted  : 
A  small  pasteboard  cone  to  fit  over  the  mouth 
was  made,  holding  a  little  cotton  wool.  On  to 
the  cotton  wool  was  put  daily  a  few  drops  of 
the  following:  Acidcarbol.  3ii-,  tr.  iodi.  etherealis, 
3ii.  creasoti  3i.,  vini.  rect.  3i.  The  cone  carry- 
ing this  was  kept  on  the  mouth  almost  constantly. 
For  the  dyspnoea  I  tried  nitro  glycerine,  but 
without  any  benefit,  and  then  gave  ammon. 
carb.  gr.  v. ;  tr.  card.  co.  m.  xv.  ;  spts.  chloro- 
formi.  m.  xv  ;  aquee  gss  ,  as  often  as  required. 
After  a  short  time  this  mixture  was  given 
regularly  every  four  hours.  The  pain  in  the 
feet  and  legs  was  treated  by  applying  bella- 
donna and  aconite  ointments  in  equal  parts 
freely,  and  bandaging  them  evenly.  In  about 
three  weeks,  the  pain  almost  disappeared.  The 
vomiting  yielded  to  nothing  but  injections  of 
morphia  and  fly  blisters  over  the  stomach. 
For  diarrhoea  gr.  ss.  of  cupri.  sulph.  was  tried, 
but  found  too  much  for  the  weakened  stomach 
to  bear;  so  that  it  was  ordered  in  gr.  one- 
eighth,  with  morphia  gr.  one-twentieth  in  the 


222 


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form  of  pills,  taken  about  every  hour.  Fl.  ext. 
coto-bark,  belladonna,  and  zinc  sxilphate 
were  tried  for  the  sweating ;  but  with  doubtful 
efficacy.  Ergotine,  however,  gave  much  better 
results,  and  caused  no  constitutional  disturb- 
ance of  any  kind.  The  throat  was  sprayed 
with  the  following  ;  acid  hydrocyan,  ^ii.  ;  acid 
lactici  3ii-  j  morphia  sulph.  gr.  iv.  ;  glycerine 
§i.  ;  aquje  ad.  jiv.  Under  this  the  sores  in  the 
throat  speedily  healed,  the  voice  began  to  return, 
and  a  glassful  of  milk  could  be  taken  at  one 
driuk.  The  ulcerated  condition  of  the  throat 
has  not  returned.  Believing  in  the  beneficial 
action  of  arsenic  in  tubercular  diseases,  the 
patient  was  ordered  liq.  sodjB  arseniatis  m.  i. 
every  half-hour  or  hour  in  milk.  Owing  to  the 
great  irritability  of  the  stomach  a  larger  dose 
could  not  be  borne.  Best  whiskey  was  pushed 
as  far  as  it  could,  keeping  inside  the  limits  of 
any  constitutional  disturbance.  In  this  way 
from  six  to  ten  ounces  per  day  were  consumed. 
Up  to  the  beginning  of  April  no  preparation  of 
cod  liver  oil  could  be  taken  ;  but  since  that 
date  hydroleine  has  been  used. 

Such  is  briefly  the  treatment  adopted  in  a 
well-marked  case  of  phthisis  with  the  usual 
conditions  of  coughing,  sweating,  diarrhoja, 
<fec.  The  patient  now  sleeps  well,  has  no 
diarrhoea.  Appetite  good  and  takes  solids;  pain 
in  feet  and  legs  gone  ;  gaining  weight  rapidly ; 
night  sweating  a  rare  occurrence  and  slight ; 
vomiting  entirely  ceased  ;  no  soreness  in  the 
throat ;  and  voice  strong.  The  pulse  is  80  ; 
tempei'ature  normal;  and  respirations  31.  She 
intends  going  away  soon  to  spend  the  summer 
in  the  country.     The  diet  was  mainly  milk. 

When  the  hopeless  condition  of  the 
patient  is  considered,  and  her  present  con- 
dition of  improvement  I  am  inclined  to 
think  that  the  acute  form  of  tubercular  phthisis 
is  not  necessarily  fatal ;  and  that  much  can  be 
done  by  persistent  eflforts  in  treating,  on  sound 
scientific  grounds,the  various  symptoms  as  they 
arise  in  each  case.  It  has  been  shown, 
especially  in  Germany,  that  arsenic  is  really 
a  remedial  agent  in  this  disease  ;  while  the 
local  treatment  by  inhalations  and  sprays 
has  been  too  much  neglected.  There  is,  per- 
haps, much  truth  in  the  theory  that,  acute 
tubercular  disease  is  really  one  of  the  continued 


fevers  with  a  definite  lesion  in  the  form  of  tuber- 
cles, as  typhoid  with  its  intestinal  ulcers.  Should 
such  really  prove  to  be  the  case,  then  we  may 
hope  for  a  fairly  successful  treatment,  and  the 
great  object  is  to  keep  up  the  patient  till  the 
disease  has  run  its  course.  There  are  three 
great  laws  that  we  may  look  upon  now  as 
fully  settled  :  1.  That  tubercular  formation 
may  cease  either  with  or  without  treatment, 
and  no  further  progress  be  made  by  the  disease. 
2.  That  tubercles  ence  formed  may  undergo  ab- 
sorption, just  as  other  inflammatory  products  do, 
on  many  occasions;  and  3.  That  if  the  formation 
of  tubercles  cease,  and  those  already  deposited 
capable  of  absorption,  then  recovery  is  possible. 
It  is,  therefore,  of  the  utmost  moment  to  make 
this  arreat  in  the  disease,  and  to  favour  the 
removal  of  existing  deposits.  The  time  may 
not  be  far  distant  when  the  question  shall  be 
finally  settled  as  to  whether  tubercle  be  an 
arrested  cell  division,  and  cell  genesis,  or  a  de- 
posit around  the  small  blood  vessels  of  gela- 
tinous inspissated  }»lasma.  The  great  proba- 
bility is  that  botli  these  factors  will  be  found 
to  exist.  Much  has  been  done  during  the  past 
ten  years  in  the  treatment  of  inflammatory  and 
febrile  diseases,  and  great  light  has  been 
thrown  upon  their  true  nature  by  the  lamp  of 
science  which  has  burned  so  brightly  in  the 
hands  of  not  a  few. 

CHRONIC   ECZEMA. 

Mr.  K ,  has  suffered  for  over  a  year  from 

eczema  ot  the  penis,  pubis,  scrotum,  perinseum, 
and  inside  of  the  thighs.  His  case  was  truly 
deplorable,  for  he  had  only  done  one  day's  work 
in  a  whole  year.  Lately  his  nervous  system 
had  been  giving  way,  and  there  was  a  constant 
tremor  on  him  when  the  slightest  movement 
was  made.  A  peculiar  feature  of  the  case  was 
that  the  scrotum  kept  constantly  moving  in  a 
strange  spiral  fashion,  and  the  patient  said  it 
felt  as  if  it  were  full  of  maggots  creeping  in 
the  skin. 

The  treatment  is  briefly  this  :  He  takes  daily 
about  a  31  of  viola  tricolor  mttde  into  an  infu- 
sion by  steeping  it  in  warm  water.  His  bowels 
were  constipated  and  were  regulated  by  mist, 
sennae  co.  For  a  short  time  at  first  he  was 
ordered  sapo  viridis  and  citrine  ointment. 
The    local   treatment    was    then   changed    to 


OF  MEDICAL  SCIENCE. 


223 


conium  baths.  These  were  made  by  putting 
a  handful  of  the  leaves  into  warm  water,  and 
after  soaking  for  a  short  time,  this  was  placed 
in  a  strong  shallow  basin  and  the  patient 
directed  to  sit  in  it  for  at  least  twenty  minutes, 
keeping  the  infusion  around  all  the  diseased 
parts  by  means  of  a  sponge  or  soft  flannel. 

He  has  been  under  treatment  just  one 
month,  and  has  made  wonderful  progress.  Prof. 
Charteris,  of  Glasgow,  as  far  as  I  can  ascertain, 
was  the  first  to  recommend   the  conium  baths. 


HOSPITAL  NOTES. 


BY  MB.  FRANK  KRAUSS. 


INTRA-PEEICARDIAL  THORACIC  ANEURISM. 
T.  E — ,  aet.  60,  employed  as  a  stableman, 
applied  at  the  Toronto  Dispensary  last  December 
for  treatment  for  a  long-standing  asthma.  Dur- 
ing his  examination  attention  was  attracted  to 
the  abnormally  powerful  pulsations  of  both 
carotids,  causing  a  well  marked  rhythmic  beat 
in  the  supra-clavicular  region  on  each  side. 
Palpation  revealed  an  unmistakable  aneurismal 
thrill.  The  case  was  diagnosed  generally,  by 
Dr.  J.  F.  W.  Ross,  as  one  of  thoracic  aneurism, 
and  the  patient  was  placed  upon  Potass.  lodid, 
and  Digitalis.  On  the  30th  of  January  he  was 
admitted  to  the  General  Hospital,  under  Dr. 
Graham's  care.  During  his  stay  in  the  institu- 
tion, the  patient  was  twice  brought  down  to  the 
theatre  for  purposes  of  clinical  instruction  by 
different  gentlemen.  On  one  occasion  the 
diagnosis  was  aneurism  of  the  innominate,  and 
on  the  other  aneurism  of  the  ascending  portion 
of  the  arch  of  the  aorta.  On  Dr.  Graham's 
departure  for  England  the  case  came  under  Dr. 
Cameron's  care.  At  this  time  the  patient  was 
comparatively  well,  though  feeble.  He  was 
able  to  sit  up,  and  complained  of  no  incon- 
venience beyond  slightly  laboured  respiration, 
frequent  constipation,  and  almost  constant  an- 
orexia. The  supra-clavicular  carotid  pulsations 
and  those  of  the  3rd  portion  of  the  subclavian 
were  strongly  marked ;  and  the  stethoscope 
revealed  pericardial  friction  and  a  rough  murmiir 
synchronous  with  both  sounds  of  the  heart,  and 
especially  noticeable  along  the  course  of  the 
subclavian  artery.  There  was  a  very  noticeable 
angular  projection  of  the  sternum  at  the  junction 


of  the  manubrium  and  gladiolus,  and  a  little  to 
the  left  of  this  and  opposite  the  base  of  the 
heart  a  weak  spot  in  the  thoracic  parietes  was 
apparent,  becoming  visibly  dilated  on  forced  ex- 
piration, as  in  coughing,  over  a  space  about 
the  size  of  a  fifty  cent  piece.  The  patient  was 
ordered  Potass.  lodid.  with  the  Extractum 
Sarzse  Fluidum,  and  perfect  quiet  was  enjoined. 

April  24th. — The  debility  and  anorexia  have 
increased  within  the  last  few  days,  and  there  is 
some  oedema  of  the  lower  extremities.  Has 
taken  no  solid  food  for  three  daj's.  Ordered  the 
citrate  of  iron  and  quinine. 

April  25th. — Appetite  slightly  improved ; 
complains  of  insomnia. 

April  30th. — Much  dyspnoea  and  pain  in  the 
thoracic  region.  CEdema  of  the  lower  extremities 
increasing.  Remains  in  bed  in  a  sitting  posture. 
Still  unable  to  sleep. 

May  Ist. — Has  taken  no  nourishment  since 
April  26th.  Extremities  growing  cold.  Spends 
the  greater  part  of  the  time,  night  and  day,  in 
a  chair,  a  return  to  bed  being  immediately 
followed  by  severe  dyspnoea. 

The  syn'ptoms  increased  in  intensity  until 
death,  which  occurred  on  the  3rd  of  May. 

The  autopsy  was  made  forty  hours  after  death. 
Considerable  difficixlty  was  experienced  in  re- 
moving the  sternum  owing  to  extensive  ossifi- 
cation of  the  costal  cartilages.  There  was 
slight  pericardial  effusion  and  numerous  general 
attrition  patches.  The  heart  was  enormously 
hypertrophied,  its  weight  being  forty-eight 
ounces,  and  the  muscular  walls  of  the  left  ven- 
tricle measuring  in  their  thickest  part,  exclusive 
of  the  columnse  carneae,  1^  inch.  The  aorta  and 
all  the  large  vessels  were  dilated  and  athero- 
matous. The  ascending  portion  of  the  arch  was 
found  to  be  the  seat  of  the  aneurism,  which  was 
tubular,  extending  as  high  up  as  the  limit  of 
the  pericardium,  with  a  large  sacculus  protuding 
outwards  and  backwards  behind  the  vena  cava 
superior.  The  internal  circumference  of  the 
aorta  in  the  narrowest  part  of  the  ascending 
portion  of  the  arch — at  the  junction  of  the  con- 
cave borders  of  the  semilunar  valves,  was  6| 
inches,  and  in  the  most  distended  portion  of  the 
sac,  I  in.  above  this,  9|  inches.  The  aortic 
valves  were  roughened  and  imperfect,  with  cal- 
careous deposits  in  the  aortic  sinuses  and  above 


224 


CANADIAN  JOURNAL 


in  the  walls  of  the  aorta.  Similar  deposits 
existed  in  most  of  the  large  arteries  examined. 
A  clot  filling  three-quarters  of  the  lumen  of 
the  artery  extended  along  the  aorta  from  the 
origin  of  the  left  subclavian  artery  to  a  point  4 
inches  below.  A  large  calcareous  plate  one 
inch  square  was  found  in  the  anterior  wall  of 
the  same  vessel  immediately  opposite  the  renal 
arteries.  The  lungs  were  cedematous  and 
emphysematous  with  double  pleural  effusion  and 
numerous  adhesions.  At  the  junction  of  the 
left  lung  and  diaphragm,  a  bony  plate,  1  inch 
by  1^  inch,  and  finch  thick,  was  found  embedded 
in  the  lung  substance.  The  abdominal  cavity 
contained  a  considerable  quanity  of  ascitic  fluid, 
and  several  long  standing  adhesions  bound  the 
liver  to  the  anterior  parietes.  Liver  small  and 
congested ;  weight  55  oz.  The  kidneys  were 
slightly  enlarged  but  otherwise  healthy  ;  com- 
bined weight  14  oz. 

ASCITES— UMBILICAL    HERNIA— PARTIAL 
CONSTRICTION— URiEMIA— DEATH. 

S.  F — ,  set.  61,  a  domestic  servant,  was 
admitted  to  the  Toronto  General  Hospital,  on 
March  20lh,  suffering  from  ascites  with  symp- 
toms of  chronic  hepatitis.  Besides  the  usual 
characteristics  there  was  nothing  worthy  of  note 
in  the  case,  except  a  long-standing  umbilical 
hernia,  which,  as  the  belly  became  distended, 
dUated,  presenting  a  roundish  bladder-like  pro- 
tuberance about  the  size  of  walnut.  The 
patient,  on  her  own  admission,  bad  been  a  hard 
drinker  for  years  past,  and  of  late,  her  indul- 
gence in  intoxicants  had  very  much  increased. 
She  had  always  been  of  a  full-habit,  but  with 
the  exception  of  dyspeptic  and  vesical  troubles 
her  health  had  been  good.  On  her  admission 
to  the  hospital  she  was  ordered  tr.  ferri  mur. 
5iv.  sp.  aetheris  nitrosi  ^i  acid  nitro-mur.  dil. 
5iv.  glycerini,  ^i,  aquce  ad  ^viii,  Jss.  to  be 
taken  every  four  hours. 

April  4th. — Paracentesis  was  performed  to- 
day, and  about  a  gallon  and  a  half  of  fluid, 
deeply  stained  with  bile,  removed. 

April  5th. — Suffered  some  pain  during  the 
night ;  bowels  were  moved  several  times  ;  pulse 
106. 

April  6th. — Expresses  herself  as  feeling  as 
well  aa  she  ever  did,  were  it  not  for  pains  in 


the  back.  Urine  is  passed  freely.  Does  not 
get  much  sleep.  A  linseed  meal  poultice  was 
ordered  for  tho  back,  and  the  following  draught 
to  be  taken  at  bed-time : — Tr.  camph,  co.  5ii, 
sp.  frumenti,  J"?  aqua^  ad  "^iv. 

April  7th. — Bowels  constipated ;  ordered 
Potass  :  bi<-tirt,  ^iv,  sulphuris,  5ii,  four  powders, 
one  to  be  taken  night  and  morning. 

April  12th. — The  constipation  continuing, 
the  powders  were  repeated. 

April  14th. — Still  progressing  favourably. 
Large  quantities  of  urine  are  passed ;  the  aver- 
age for  the  24  hours  being  estimated  by  the 
patient  at  3  quarts. 

April  16  th. — The  abdomen  begins  to  show 
signs  of  redistension.  Over  two  quarts  of  urine 
(by  measurement)  were  passed  during  the  last 
24  hours. 

April  19th. — Powders  were  repeated;  and 
the  patient  complaining  of  rheumatic  pains 
the  following  lotion  was  ordered  to  be  applied  : 
— Chloroformi,  5iii,  lin  :  belladonn,  5iii,  tr. 
aconiti,  5i,  lin.    opU,  5iii>  lii-    sap.    co.,  ad  jii. 

April  23th. — Constipation  continues  ;  pow- 
ders repeated  with  the  substitution  of  Pulv. 
jalapse  co.  for  the  sulphur. 

May  1st. — Patient  complains  of  great  pain 
and  incessant  vomiting,  the  ejecta  liquid, greenish 
black  in  colour,  and  very  offensive ;  pulse  73. 

The  abdomen  gives  a  dull  note  on  percussion, 
except  immediately  over  the  umbilicus,  which 
is  again  tumefied  and  tense ;  at  this  spot 
resonance  is  elicited,  but  there  is  no  sign  of 
constriction  of  the  umbilical  ring,  the  gut 
being  apparently  adherent  on  left  side  but 
allowing  the  finger  to  penetrate  between  it  and 
wall  on  right  side.  Ordered  an  enema  of  tur- 
pentine and  soapsuds,  and  the  following  : — 
Morph.  sulph,  gr.  ij,  atropice  sulph,  gr.  4-25, 
bismuth,  trisnitr,  3iv,  acid,  hydrocyan  (Scheele) 
mviii,  mucilag.  acacioe  ^iv  ;  Jss  to  be  taken 
every  two  or  three  hours. 

May  2ud. — The  vomiting  continues ;  com- 
plains of  intense  drowsiness ;  morphia  mixture 
suspended. 

May  3rd. — When  seen  at  three  o'clock  this 
afternoon  the  patient  was  comatose,  having  been 
in  that  condition  since  8  o'clock  this  morning, 
when  the  vomiting  ceased.  Pulse  128  ;  tem- 
perature   102-2,5.     Pupils   dilated,   breathing 


OF  MEDICAL  SCIENCE. 


325 


stertorous,  face  and  nose  bathed  in  offensive 
Perspiration,  At  6  p.  m.  the  pulse  was  140. 
Passes  water  in  the  bed,  quantity  not  ascer- 
tainable. 

May  4th. — Died  at  5  o'clock  this  morning. 
The  post-mortem  examination  revealed  nothing 
of  interest  in  the  thoracic  cavity.     The  abdomen 
was  filled  with  ascitic  fluid  stained  with  bile, 
but   nothing   like   so    deeply    tinged   as   that 
obtained  on  tapping.     The  umbilical  hernia  was 
pinched  and  deeply  congested  but  not  lustreless 
nor  lymphy,  a  knuckle  of  bowel  2|  inches  in 
length  being  contained  in   the  sac,  the  neck  o' 
which  was  constricted,  being  just  large  enough 
to  admit  the  point  of  the  forefinger.     The  par- 
ietal peritoneum  opposite  injected.     The  uterus 
was  the  seat  of  extensive  fibroid  growth  pro- 
jecting into  the  abdominal  cavity,     One  of  these 
of  large  size  was  found  at  the  fundus,  projecting 
so  far  upwards  that  a  tape  line  stretched  from 
the  attachment  of  one  Fallopian  tube  over  the 
fundus  to  that  of  the  other  tube  gave  a  measure- 
ment of  10  inches,     A  second  myomatous  mass 
5^  inches  in  circumference  projected  forwards 
and  outwards  immediately  to  the  right  of  the 
mesial  line  and  opposite  the  attachment  of  the 
Fallopian  tube  ;  a  third  outwards,  a  little  lower 
down  on  the  opposite  side  ;  and  a  fourth  back- 
wards and  outwards  on  the  back  of  the  neck  to 
the  right  side.      The  extreme   length   of  the 
uterus   in   the   longitudinal  direction  was  7i 
inches  ;  its  circumference  opposite  the  Fallopian 
tubes   13|  inches.      The  left  ovary   was   nor- 
mal.    The  right  had  almost  disappeared,  and 
there  presented  at  its  upper  and  outer  part  (in 
the   parovarium  ])  a  cyst  the  size  of  a  small 
orange,  apparently  unilocular  and  nearly  full  of 
a  semi-transparent  fluid.     Its  greatest  circum- 
ference  was    7|    inches,  and   in    a   transverse 
direction  6  inches.     At  its  base  was  a  smaller 
cyst  about  the  size  of  a  large  bean,  tenser  than 
the  former,  and  apparently  multilocular  or  con- 
taining solid  as  well  as  fluid  matter.     The  liver 
was  small,  hard  and  contracted,  yellowish  white 
in  colour,  granular,  and  extremely  fatty.    Other 
organs  macroscopically  healthy. 


M.  Bechamp  says  that  he  has  discovered 
living  organisms  in  the  gastric  juice  similar  to 
the  microzymes  of  the  pancreas  and  liver,  M, 
Gautier  denies  that  these  are  living  organisms, 
and  states  that  they  are  merely  protoplasmic 
granulations. — L'  Union  Med. 


A  CASE  OF  ANEURISM  OF  THE 
THORACIC  AORTA,  RUPTURE  INTO 
THE  LUNG  AND  PLEURAL  CAVITY. 

BY   J.    E.    GRAHAM,    M.D.,    L.R.C.P.,    LONDON. 

Assistant  Lecturer  in  Medicine,  Lecturer  on  Pattiology,  Toronto 
School  of  Medicine,  &c. 

G.  A >aged  48  years  ;  residence,  Toronto. 

Admitted   January    25th,  1882,     Patient  has 
served  seven  years  in  the  English  Army. 

Family  History. — Father  died  of  old  age. 
Mother  living.  He  has  three  brothers  and  two 
sisters  living.  No  history  of  lung  trouble  in 
the  family.  According  to  his  own  statement 
he  was  a  strong  healthy  man  up  to  the  com- 
mencement of  the  present  illness. 

The  present  illness  would  seem  to  have  orig- 
inated in  a  bad  cold  which  he  contracted  while 
working  on  a  railroad.  At  that  time  he  had  no 
pain  and  very  little  cough.  Three  weeks  ago 
he  had  a  severe  pain  in  the  left  side  which  lasted 
about  a  week.  He  has  noticed  that  during  the 
past  month  his  voice  has  been  gradually  be- 
coming weaker.  He  now  speaks  quite  hoarsely. 
He  complains  at  present  of  pain  in  the  left  side, 
on  moving  or  coughing,  with  slight  difficulty  of 
breathing.  The  loss  of  voice  has  increased  very 
much  during  the  last  two  or  three  days.  Ap- 
petite poor ;  bowels  somewhat  constipated. 
Urine  normal  in  quantity  and  quality.  Pulse  76, 
respiration  24,  temperature  98.  On  physical 
examination  of  the  chest  the  following  condi- 
tions were  found  :  Absence  of  vocal  fremitus 
over  the  lower  half  of  left  side.  Increased  vocal 
fremitus  over  the  right  side.  Dulness  amount- 
ing to  flatness  over  the  lower  two-thirds  of  the 
posterior  aspect  of  chest.  Increased  resonance 
on  the  right  side.  Total  absence  of  breathing 
and  voice  sounds  over  the  lower  two-thirds  of 
chest.  They  were  more  distinct  in  the  upper 
part,  both  in  front  and  behind.  No  adventitious 
sound  or  aneurismal  bruit  was  heard,  although 
a  careful  examination  was  made.  The  diagnosis 
made  at  the  time  was  chronic  pleurisy,  although 
some  signs,  such  as  the  loss  of  voice,  could  not  in 
this  way  be  accounted  for,  and  the  patient  ap- 
peared weaker  and  more  ill  than  one  would 
expect  from  such  a  lesion  ;  especially  as  it  did 
not  appear  from  the  examination  that  a  very 
large  amount  of  fluid  existed  in  the  side. 

The  treatment  adopted  was  potass  iodid.  and 


226 


CANADIAN  JOURNAL 


tr.  of  digitalis,  also  pulv.  jalapse  co.,  58S.  each 
morning.  The  examination  was  made  on 
Thursday.  On  Friday  and  Saturday  the  patient 
did  not  appear  to  te  doing  well.  On  Sunday 
he  was  not  seen.  On  Monday  I  found  him 
much  worse.  On  Saturday  night  he  coughed 
up  a  considerable  quantity  of  blood  ;  since  that 
time  he  has  become  rapidly  weaker.  Wishing  to 
be  more  certain  in  the  diagnosis,  as  well  as  to 
try  and  relieve  the  rapid  breathing,  I  drew  off 
a  quantity  of  fluid  from  the  side.  It  was  made 
up  entirely  of  bloody  serum,  and  resembled 
very  much  the  serum  which  surrounds  a  co- 
agulum. 

My  attention  was  then  directed  to  the  possi- 
sibility  of  an  aneurism  of  the  thoracic  aorta, 
but  could  yet  see  no  sign  of  one.  Patient  died 
on  Monday  about  midnight.  Post  mortem 
made  14  hours  after  death. 

The  left  pleural  cavity  was  filled  with  coagu- 
lated blood  and  bloody  serum.  The  lung, 
although  much  smaller  than  normal,  was  not  so 
small  or  carnified  as  is  often  the  case  in  chronic 
pleurisy. 

On  examining  the  aorta,  a  dilatation  was 
discovered  at  the  junction  of  the  descending 
portion  of  the  arch,  and  the  thoracic  aorta 
proper. 

The  aneurism  was  large  and  irregular,  and 
extended  some  distance  down  the  aorta.  Two 
ruptures  were  found,  one  into  the  lung  sub- 
stance, and  one  into  the  pleural  cavity. 

A  large  clot  existed  in  the  upper  part  of  the 
lung,  which  connected  with  the  rupture  of  the 
aneurismal  sac. 

The  heart  was  small,  otherwise  normal.  The 
right  lung  was  also  healthy. 

The  history  of  this  case  shows  the  difficulty 
of  making  a  diagnosis  of  an  aneurism  extended 
into  the  back  part  of  the  thorax.  It  is  possible 
that  if  a  moie  careful  examination  had  been 
made  of  the  upper  and  anterior  part  of  the  left 
side,  a  bruit  might  have  been  discovered.  I  am 
confident  that  none  could  be  heard  over  the 
posterior  surface. 

I  am  reminded  by  this,  of  a  somewhat  sim- 
liar  case  which  occurred  in  Guy's  Hospital. 
The  aneurism  had  destroyed  the  bodies  of  the 
vertebrcE,  and  by  pressure  on  the  spinal  cord, 
produced  paraplegia.     The  presence  of  the  an- 


eurism was  not  made  out  until  the  post  mortem 
revealed  it. 

It  is  probable  that  in  the  case  given  a  pre- 
vious pleurisy  had  existed,  owing  to  the  presence 
of  the  aneurism,  and  that  a  serious  rupture 
took  place  on  the  Saturday  evening  into  the 
lung  substance,  when  the  blood  was  coughed  up. 
This  rupture  into  the  pleural  cavity  probably  oc 
curred  during  Sunday  or  Monday.  The  flow  of 
blood  into  the  cavity  would  not  be  so  rapid  on 
account  of  its  having  previously  been  partially 
filled  with  serum.  How  long  the  aneurism  had 
been  in  existence,  it  is  difiicult  to  say,  but  most 
probably  duringthelast  few  weeks  this  dilatation 
had  been  rapid,  as  shown  by  the  loss  of  voice, 
and  there  being  no  hypertrophy  of  the  heart. 


^0Utiim»:  ^tAUm. 


THE  SLOW  PULSE  AND  DISTURBAN- 
CES IN  THE  RHYTHM  OF  THE  PULSE. 

BY  T.  A.  M'BRIDE,  M.D.,  NEW  YORK. 

A  pulse  of  60  or  less  is  usually  pathological. 
Occasionally  we  meet  with  cases  in  which  the 
pulse- beat  in  health  is  habitually  below  60,  but 
such  examples  are  infrequent. 

The  following  schema,  taken  from  Dr.  T. 
Lauder  Brunton's  book  on  the  "Experimental 
Investigations  of  the  Action  of  Medicines,  Part 

1.  Circulation,"  London,  1875,  exhibits  the 
causes  of  slow  action  of  the  heart  as  determined 
by  experiment  on  animals,  and  if  you  will 
keep  this  before  you,  you  will  find  that  it  will 
assist  you  in  the  explanation  of  many  cases  in 
which  a  slow  pulse  is  observed  : 

A. — Irritation  of  vagus  roots  :  1.  Directly 
by  the   action  of  an   excitant,  drug,   or  pain. 

2.  Indirectly  by  increased  blood-pressure.  3. 
Indirectly  by  increased  CO2  in  blood.  4.  Re- 
flexly  by  irritation  of  some  other  nerve. 

B. — Irritation  of  vagus  ends  in  the  heart. 

C. — fncreased  excitability  of  vagus  ends  in 
the  heart. 

D.- — Weakness  of  the  heart :  1.  Paralysis 
of  cardiac  ganglia.  2.  Paralysis  of  muscular 
fibres  of  the  heart.  3.  Degeneration  of  mus- 
cular fibres  of  the  heart. 

A  slow  pulse  is  a  prominent  or  important 


OF  MEDICAL  SCIENCE. 


227 


eymptoin  in   the  following    pathological   con- 
ditions : 

1.  Fevers. — la  typhus,  although  the  pulse, 
as  a  rule,  ranges  from  100  to  120,  a  slow  pulse 
is  not  infrequently  observed.  Murchison  re- 
ports cases  in  which  the  pulse  was  28  to  40. 
In  such  cases  there  is  usually  very  great  pros- 
tration, and  the  heart  may  be  seriously  affected 
by  pathological  changes  which  are  common  in 
this  disease.  In  convalesence  a  slow  pulse  is 
very  often  present.  It  is  well  to  bear  in  mind 
that  in  adynamic  conditions  the  pulse-beat  does 
not  always  correspond  to  every  ventricular 
contraction.  Often  a  pulse-beat  at  the  wrist 
occurs  only  after  two  or  three  contractions  of 
the  ventricle  have  taken  place. 

In  relapsing  fever,  although  the  frequency 
of  the  pulse  is  very  great  in  the  pyretic  periods, 
yet  in  the  intervals,  it  is  much  diminished  in 
rate. 

"  In  the  first  half  of  the  apyretic  stage, 
however,  the  pulse  usually  continues  a  little 
above  the  normal  standard,  but  for  some  days 
before  the  relapse,  when  the  temperature  has 
regained  its  normal  height,  the  pulse  is  in 
many  cases  irregularly  slow — often  not  exceed- 
ing 40  to  50 ;  but  assuming  the  erect  position 
will  sometimes  raise  it  from  50  to  upward  of 
100.  The  slow  pulse  is  not  due  to  slowness 
in  the  contraction  of  the  heart,  but  to  a  pro- 
longation of  the  pause," 

2.  Diseases  of  Heart  and  Lungs. — In  attacks 
of  syncope  the  pulse  may  fall  to  20,  and  even 
lower,  and  continue  at  this  rate  for  some 
minutes.  In  the  early  stages  of  endo  and 
peri-carditis  a  pulse  of  diminished  frequency 
is  sometimes  observed.  In  most  congeni- 
tal affections  of  the  heart,  and  particularly 
in  the  morbus  c<xruleus  a  slow  pulse  is  present. 
•  In  fatty  degeneration  of  the  heart  and  in 
stenosis  of  the  aortic  orifice,  the  diminution 
in  the  rate  of  pulse  becomes  a  sign  of  some 
importance  in  diagnosis  and  prognosis.  In 
aortic  stenosis  the  pulse  is  seldom  lower  than 
50,  and  is  small  and  incompressible.  In  fatty 
degeneration  or  Quain's  disease  it  may  fall  as 
low  as  30,  or  even  20,  and  a  pulse  of  10,  with 
continuance  of  life  has  been  observed.  The 
pulse  is  small,  gaseous,  easily  compressible.  A 
slow  pulse,  with  epiletiform  seizures,  has  also 


been  observed  in  cases  in  which  fibrinous 
masses  were  found  affixed  to  the  walls  of  the 
ventricular  cavity  after  death.  Permanent 
slow  pulse  has  likewise  been  observed  to  follow 
attacks  of  diphtheria,  and  the  explanation  of- 
fered for  this  has  been  the  frequent  occurrence 
of  fibrinous  masses  in  the  heart,  which  become 
attached  to  the  walls  of  the  heart.  Charcot, 
however,  has  suggested  that  in  such  cases  some 
lesion  of  the  medulla  or  cervical  cord  may  be 
present. 

In  pleurisy,  with  abundant  effusion,  after 
the  crisis  of  croupous  pneumonia,  in  the  early 
stages  of  grangrene  of  the  lung,  a  slow  pulse 
is  often  encountered.  In  all  diseases  of  the 
air-passages,  or  of  the  lungs,  in  which  carbolic 
acid  poisoning  occurs,  the  pulse  at  first  is  slow, 
by  reason  of  irritation  of  the  vagus  roots  by 
this  poison,  but  later  the  pulse  becomes  very 
much  increased  in  frequency,  from  paralysis  of 
the  vagus  roots  by  the  increase  of  the  poison 
in  the  blood.  In  pulmonary  turberculosis  a 
rather  frequent  pulse  is  the  rule,  but  some- 
times the  pulse  diminishes  in  frequency,  and 
Traube  states  that  this  is  a  sign  of  bad  import. 
3.  Affections  of  the  Nervous  System. — In  the 
first  stages  of  cerebral  haemorrhage  and  cere- 
bral compression  a  slow  pulse  is  of  frequent 
occurrence,  and  may  also  be  present  throughout 
the  attack,  but,  usually,  and  especially  when 
death  is  imminent,  the  rapid  pulse  succeeds. 

In  what  is  usually  termed  the  second  stage 
of  almost  all  of  the  varieties  of  meningitis, 
the  pulse  is  apt  to  be  slow.  Niemeyer  and 
Traube  assert  that  if  in  the  course  of  any 
disease  with  head-symptoms,  the  pulse  should 
fall  from  a  high  rate,  as  110  or  120  to  50,  60, 
or  70,  suspicion  should  at  once  be  directed 
strongly  to  the  occurrence  of  a  meningitis.  The 
diminished  frequency  is  most  marked  in  basal 
and  especially  in  basilar  meningitis,  in  which 
latter  affection  it  may  be  40,  or  less.  In  frac- 
tures of  the  cervical  vertebrae,  a  slow  pulse  is 
common.  Mr.  Hutchinson  reports  a  case  of 
fracture  of  the  fifth  and  sixth  cervical  vertebrae, 
in  which  a  regular  pulse  of  48  was  observed. 
According  to  Gurlt,  the  pulse  may  fall  as  low 
as  36,  and  even  to  20.  Fractures  of  the  first 
dorsal  vertebra  seem  to  be  accompanied  for  a 
time  also  by  this  slowness  of  the  pulse.     The 


228 


CANADIAN  JOURNAL 


rule  is  for  this  slow  action  of  the  heart  to  be 
transitory,  and  to  be  replaced  by  a  very  great 
increase  in  the  frequency,  and  this  occurrence 
has  usually  a  bad  significance.  The  slow  pulse 
may,  however,  continue  for  some  time.  In  a 
case  of  Rosenthal  the  pulse  oscillated  between 
48  and  56  for  four  weeks,  and  the  patient  a 
child,  aged  fifteen,  recovered.  In  certain  cases 
of  irritation  of  the  cervical  spinal  cord  by 
neoplasm,  tumore,  pachymeningitis,  etc.,  a  slow 
pulse  has  often  been  noted.  Charcot  has  ob- 
served three  cases.  In  one  the  pulse  was  from 
20  to  30.  In  such  cases  syncopal  apoplectiform 
and  epileptiform  attacks  frequently  occur,  and 
in  the  attacks  the  pulse  may  fall  to  15  or  20. 
He  also  refers  to  a  case  in  which  there  was  a 
decided  narrowing  of  the  vertrebal  canal  near 
the  occipital  foramen,  in  which  a  slow  pulse 
was  observed.  In  melancholia  a  slow  and 
feeble  pulse  is  common.  Spring  records  a  case 
with  a  pulse  of  15.  In  migraine  and  hemi- 
crania  the  pulse  rate  is  low  during  attacks,  as 
a  rule.  Lieving  quotes  WoUendorf  as  fol- 
lows :  "  From  the  beginning  and  during  the 
continuation  of  hemicrania  the  rate  of  cardiac 
pulsations  is  considerably  lowered,  the  normal 
pulse  rate  of  from  72  to  76  to  the  minute, 
sinking  to  from  56  to  48  beats."  Lieving 
also  records  cases  of  gastralgia,  hybterical 
asthma,  epilepsy  with  gastric  aura,  in  which, 
during  the  attacks,  the  pulse  would  fall  to  50 
and  lower ;  also  cases  of  hiccough,  in  which  the 
pulse-rate  was  so  reduced  as  to  be  synchronous 
with  the  hiccough. 

4.  In  the  period  of  invasion  of  erysipelas, 
diphtheria,  and  some  of  the  exanthemata ;  in 
scleroma  neonatorum ;  in  convalescence  from 
gastro-intestinal  catarrh  ;  in  scurvy,  gout ;  in 
certain  cases  of  malarial  affection ;  in  jaundice ; 
in  the  attacks  of  lead  colic ;  in  ergotism  ;  and 
lastly,  in  some  cases  of  ursemic  poisoning  in 
the  course  of  Bright's  disease,  a  pulse  of  50 
and  less  is  not  infrequently  observed. 

Rhythm. — The  disturbances  of  the  rhythm 
of  the  pulse  are  those  of  intermission  and 
irregularity. 

An  intermittent  pulse  is  one  in  which  a 
pause  occurs  between  the  pulsations,  which  is 
equal  to  the  time  occupied  by  one  or  more 
pulsations. 


The  intermittent  pulse  may  be  present  iu 
perfectly  healthy  persons,  and  may  have 
always  existed.  Dr.  B.  W.  Richardson  has 
also  shown  that  it  may  be  produced  in  a  man 
otherwise  healthy,  by  grief,  terror,  anxiety, 
fatigue,  pain,  passion,  adverse  fortunes,  etc. 
When  it  is  the  only  peculiarity  of  the  pulse  it 
is  not  a  sign  of  any  great  importance,  although 
it  is  observed  often  in  cerebral  haemorr- 
hage and  in  cerebral  compression  from 
fractures  of  the  skull,  in  tumours  of  the 
brain,  in  gout  and  syphilis.  It  is  present 
often  in  dilatation  and  degeneration  of  the 
heart,  but  is  then  associated  usually  with  an 
irregular  pulse,  especially  if  the  patient  moves 
about.  The  ventricle  requires  the  stimulus  of 
a  grea'er  quantity  of  blood  before  it  will  con- 
tract, and  one,  two,  or  three  contractions  of 
the  auricle  may  occur  before  there  is  a  pulse- 
beat.  In  this  way,  since  varying  quantities  of 
blood  are  thrown  into  the  arteries,  irregularity 
of  the  pulse  results. 

Irregularity  of  the  pulse  is  a  much  more  im- 
portant symptom  by  itself  than  the  pulse  with 
intermissions.  The  following  are  some  of  the 
diseases  or  conditions  in  which  an  irregular 
pulse  is  a  sign  of  importance  : 

1.  Neurosal  Irregularity. — The  irregularity 
of  the  pulse  which  is  often  very  great,  may  be 
provoked  by  peripheral  irritation,  as  dyspepsia, 
meteorism,  worms,  etc.  It  often  occurs  in 
hysteria  and  hypochondriasis,  and  in  anajmia. 
With  the  irregularity  there  is  often  intermis- 
sion of  the  pulse.  In  this  form  of  irregularity, 
the  neurosal,  exertion,  effort,  or  movements  of 
the  body  of  any  kind,  have  but  little  effect 
upon  the  disturbed  rhythm  of  the  pulse.  The 
irregularity  and  intermissions  are  not  in- 
creased, and  sometimes  are  even  diminished. 
Irregularity  and  intermissions  of  the  pulse, 
however,  when  dependent  upon  valvular  dis- 
ease and  degeneration  of  the  structure  of  the 
heart,  are  much  augmented  by  the  slightest 
movement.  The  exaggerated  changes  in  the 
rhythm  are  accompanied  by  dyspnoea,  palpita- 
tions, and  often  synope. 

2.  Irregularity  of  Pulse  in  Heart  Disease. — 
In  most  diseases  of  the  heart  the  occurrence  of 
degeneration  of  the  muscular  substance  is 
marked  by  the  appearance  of  an  irregular  and 


OF  MEDICAL  SCIENCE. 


229 


intermittent  pulse.  There  is  a  variety  of  val- 
vular disease  of  the  heart,  however,  in  which 
the  irregular  pulse  is  quite  constantly  present, 
and  without  any  degenerative  change  having 
occurred  in  the  walls  of  the  heart — mitral 
insufl&ciency.  The  irregular  pulse  is  frequently 
present  in  cases  of  mitral  insufficiency  for 
years,  and  the  pulse  is  called  the  "  mitral 
pulse."  Sometimes  the  irregularity  of  the 
pulse  cannot  be  appreciated  until  the  arm  of 
the  patient  is  elevated,  and  in  this  position  the 
irregularity  is  readily  noted. 

3.  Syphilis. — Fournier  has  called  attention 
to  the  fact  that  irregularity  is  of  frequent 
occurrence  in  the  secondary  period  of  syphilis. 
It  may  be  in  these  cases  irregular  to-day  and 
regular  to-morrow.  It  may  be  irregular  in  the 
morning  and  regular  in  the  evening.  It  may 
be  associated  with  the  other  phenomena  of 
secondary  syphilis,  or  it  may  occur  without 
any  other  symptoms  of  the  disease  being  pre- 
sent at  that  time. 

4.  Dr.  B.  W.  Richardson  refers  to  two 
forms  of  irregularity  of  the  pulse,  which  it  is 
of  importance  to  recognize  :  "  Acute  Irregu- 
larity in  Time"  and  "Prolonged  Irregularity 
in  Time." 

"  Acute  Irregularity  in  Time  :"  Each  stroke 
is  given  in  the  correct  order  of  succession,  the 
one  stroke  to  the  other,  but  in  series  of  five, 
ten,  or  other  number  of  beats,  differing  in  rate 
from  other  series.  In  cases  of  very  feeble 
heart  we  often  meet  this  condition  ;  we  meet  it 
in  ansemia,  we  meet  it  after  loss  of  blood,  and 
other  states  of  depression. 

"  Prolonged  Irregularity  of  Time  :"  This  is 
a  condition  in  which  the  pulse  shall,  during 
one  minute,  register,  say  70,  and  if  counted 
through  a  succeeding  minute  90  to  100  beats. 
This  form  of  irregularity  in  relation  of  time  is 
met  with  most  distinctively  in  cases  of  acute 
cerebral  diseases,  especially  in  the  hydroce- 
phalus of  children.  In  hydrocephalus,  ac- 
cording to  my  experience,  it  is  a  fatal  sign.  I 
have  never  known  an  instance  of  recovery 
when,  with  other  acute  disease,  this  prolonged 
irregularity  has  been  markedly  present. — 
Walsh's  Retrospect. 

Dr.  Graham  of  Toronto  is  now  in  Vienna. 


ACUTE  RHEUMATISM  COMPLICATED 
BY  ACUTE  ENDO-PERICARDITIS. 

BY  WM.    PEPPER,    M.D. 
Professor  of  Clinical  Medicine,  University  of  Pennsylvania. 

We  have  been  receiving  a  number  of  Russian 
refugees  lately.  They  have  been  unable  to 
speak  any  dialect  with  which  we  are  familiar, 
and  we  have,  therefore,  been  obliged  to  diag- 
nose every  case  by  physical  exploration. 

This  very  nice-looking  lady  came  in  yester- 
day, evidently  suffering  from  acute  inflamma- 
tory rheumatism,  as  you  can  see  at  once,  by 
glancing  at  the  left  wrist  joint.  This  is  like 
studying  the  diseases  of  children  and  animals. 
You  will  often  come  across  cases  where,  either 
from  the  condition  of  the  patient  or  his  in- 
ability to  speak  your  language,  you  will  have 
to  depend  on  the  physiognomy,  direct  explora- 
tion of  organs,  and  the  use  of  instruments  of 
precision,  in  order  to  make  the  diagnosis.  The 
wrist  joint  is  not  much  swollen,  but  the  way  in 
which  she  holds  it  is  perfectly  characteristic. 
Her  temperature  is  101.6°.  There  is  a  decided 
mitral  systolic  murmur,  quite  loud  and  rather 
coarse,  supposing  it  to  bo  recent.  There  is  no 
aortic  trouble.  In  addition  to  the  mitral 
systolic,  I  hear  a  faint  mitral  pre-systolic  mur- 
mur, showing  that  there  is  a  little  roughening 
as  well  as  insufficiency  of  the  mitral  valve. 
With  this  there  is  quite  a  distinct,  churning, 
friction  sound  at  the  point  of  the  heart.  We 
have,  therefore,  an  endo-pericarditis.  Pressure 
over  the  heart  is  painful.  The  hands  and  the 
joints  of  the  lower  extremities  are  also  affected 
with  rheumatic  inflammation. 

What  is  the  treatment  ?  We  have  moderate 
fever,  acute  rheumatic  poly-arthritis,  and  acute 
endo  pericarditis.  The  tongue  is  dry  and 
brownish  in  the  centre.  In  cases  of  this  kind, 
where  the  heart  is  already  affected,  I  do  not 
like  to  depend  upon  salicylic  acid  or  the 
salicylates.  My  observation  has  been  adverse 
to  their  use  in  complications  of  a  rheumatic 
character.  In  simple  acute  rheumatism  (rheu- 
matic fever  with  poly-arthritis),  I  like  to  try 
the  salicylates,  and  I  give  them  a  fair  trial  for 
a  few  days.  If  they  do  not  then  do  good,  it  is 
not  worth  while  to  continue  their  use. 

In  this  case  the  fever  is  moderate,  and  does 


230 


CANADIAN  JOURNAL 


not  constitute  a  serious  complication.  As  long 
as  the  fever  is  under  103°,  it  is  of  no  conse- 
quence. The  worst  complication  is  the  cardiac 
trouble,  which,  unless  relieved,  is  going  to 
leave  this  woman  crippled  for  life.  We  must 
resort  to  such  remedies  as  will,  as  quickly  as 
possible,  affect  the  heart.  I,  therefore,  placed 
this  woman  upon  calomel,  opium,  and  digitalis, 
giving  her  quinine,  in  moderate  doses,  by  the 
rectum.  She  has  received  eight  graihs  three 
times  a  day,  dissolved,  by  the  aid  of  a  few 
drops  of  dilute  sulphuric  acid,  in  three  ounces 
of  liquid.  When  necessary,  it  was  guarded  by 
a  few  drops  of  the  deodorized  tincture  of  opium. 
She  was  given  the  following  pill : — 

R.     Hydrarg.  chloridi  mitis, 
Pulv,  opii, 

Pulv.  digitalis,       aa       gr.  ^.       M. 
Ft.  pil.  No.  1. 

SiG. — One  every  four  hours. 

This  will,  in  the  course  of  four  or  five  dajs, 
slightly  touch  the  gums,  which  is  the  condition 
T  wish  to  produce.  Over  the  cardiac  region  I 
shall  place  a  blister,  four  inches  square,  fol- 
lowed in  a  few  hours  by  a  poultice,  and  after- 
wards dressed  with  diluted  resin  cerate  (resin 
cerate,  1  part,  cosmoline  2  parts).  The  affected 
joints  will  be  painted  with  iodine,  morning  and 
evening,  and  wrapped  in  raw  cotton  or  wool. 
She  will  receive  a  light  diet  of  gruels,  broths, 
and  milk  diluted  with  an  equal  part  of  water. 
Of  these  she  can  have  as  much  as  she  will  take. 
She  may  also  have  a  little  weak  lemonade.  It 
will  be  interesting  to  watch  the  course  of  this 
endocarditis.  Her  general  appearance  is  more 
favourable  than  we  might  have  expected.  The 
moderate  fever  and  absence  of  nervous  com- 
plications justify  us  in  hoping  that  we  shall 
overcome  the  cardiac  trouble. — Medical  and 
Surgical  Reporter. 


Prof.  I.  Moleschott,  of  Rome  {Wien.  Med. 
Woch.)  in  a  lengthy  article  gives  a  careful 
analysis  of  the  treatment  of  diabetes  mellitus 
with  iodoform.  He  is  of  opinion  that  it  is  of 
decided  advantage,  and  exerts  a  greater  control 
over  the  amount  of  sugar  than  the  amount  of 
fluid  passed.  His  formula  is :  iodoform,  1  '0 
gr. ;  ext.  lactuc.  sat.,  1*0  gr.  ;  cumarin,  0-1 
gr.  ;  gummi  acac  q.  s.  ;  ft.  pil.  20.  One  twice 
a  day,  increasing  to  two  four  times  a  day. 


The  Proper  Dose  of  Conium. — Seguin 
(Archiv.  of  Medicine,  A\iri\,  1882),  commenting 
upon  the  dose  of  this  agent  (he  employs  the 
fluid  extract,  Squibb),  says  that  to  get  any 
effect  from  it  we  must  use  much  larger  doses 
than  are  usually  recommended.  He  has  used 
it  in  chorea,  spasm  of  paralysed  limbs,  general 
irritability,  and  insomnia.  To  obtain  muscular 
relaxation  as  in  chorea,  after  a  few  tentative 
doses  of  20  and  40  minims,  he  gives  60,  80,  or 
100  minims,  which  cause  ptosis  (sometimes 
diplopia)  and  paresis  of  arms  and  legs.  He  does 
not  x'epeat  until  the  effects  have  passed  off — 
12  to  24  hours.  He  has  almost  perfectly  cured 
a  chronic  adult  chorea  ot  14  years'  duration  by 
teaspoonful  doses  daily  for  a  month  or  more. 
Many  cases  of  insomnia  with  wakefulness  in 
the  first  part  of  the  night,  more  especially 
those  with  fidgets  or  physical  restlessness  are 
very  much  benefitted  by  conium — m.  xx  with 
gr.  XX  bromide  of  potassium,  to  be  repeated  if 
necessary.  The  indications  of  conium  can  only 
be  fulfilled  by  obtaining  its  physiological  effects 
between  which  and  the  toxic  effects  there  is  a 
wide  distance. — Marylarid  Medical  Journal. 


Diagnosis  of  Death. — In  an  article  on 
hasty  l)urials,  the  Med.  Press  and  Circular, 
after  referring  to  a  recent  case  in  Brussels 
where  a  cataleptic  child  barely  escaped  being 
burned,  states  that  an  ophthalmoscopic  ex- 
amination is  an  excellent  means  of  diagnosis. 
During  the  last  agony  it  is  easy  to  identify  the 
gradual  anoemia  of  the  arteries  and  the  pallor  of 
the  optic  papilla.  When  life  is  extinct  the 
veins  become  separated  at  points  as  if  cut  by  a 
knife,  due  to  the  liberation  of  the  gases  of  the 
blood.  The  phenomenon  is  called  pneumatosis. 
— Louisville  Medical  News. 


The  Hypodermic  Use  ofAmyl  Nitrite. — 
J.  J.  Frederic  Barnes,  M.'{.C.P.,  F.R.C.S. 
writing  to  the  British  Medical  Journal,  says  he 
has  employed  the  Nitrite  of  Amyl  hypodermi- 
cally,  upwards  of  thirty  times  during  the  last 
eighteen  months.  He  ust;s  a  ten  per.  cent, 
solution  in  rectified  spirit,  injecting  ten  min- 
ims (one  minim  of  the  Nitrite)  each  time. 
He  reports  instant  relief  in  lumbago,  paraffin 
poisoning,  and  duodenal  colic. 


OF  MEDICAL  SCIENCE. 


231 


Dr.  Karl  Korbl   (Wien.  Med.  Woch.)  records 
23  cases  of  lymphoma  treated  by  subcutaneous 
injections.     He  tried  Fowler's  solution,  carbolic 
acid,  iodoform,  etc.  for  this  purpose.     Latterly 
he  has  used  tinct.  iodi,  and  injects  into  the 
most  prominent  part  of  the  swelling  a  sufficient 
amount   to   cause   distinct   tension.      This   is 

was  fibrous.  He  was  not  able  to  produce  the 
fracture  experimentally.  At  a  subsequent 
meeting,  Dr.  Shepherd  showed  a  fourth  speci- 
men in  which  there  was  bony  union.  Unfortu- 
nately, there  was  no  history  of  any  of  the  cases. 
— Medical  News. 

followed  by  much  swelling   and  pain,  but  by 
the  third  day  these  are  nearly  gone  and  massage 
is   then    practised.      The   injecting   is   to   be 
repeated  as  may  be  required. 

Removal  of  Plaster-of-Paris  Bandages. — 
Dr.  F.  H.  Murdock,  of  Bradford,  Pa.,  says: 
A  very  convenient  way  to  remove  a  plaster-of- 
Paris  bandage  is  as   follows  :     Take  a  strong 

The  Arrest  of  Fermentation. — M.    Paul 
Bert,  following  in  the   steps  of  M.  Bechamp, 
has,  by  a  series  of  experiments,  discovered  that 
oxidised  water   arrests  fermentation  resulting 
from  the  presence  of  living  organisms,  (vibrios, 
bacteria,  yeast  cells,  &c.),  but  is  inert  in  the 
presence  of  amorphous  ferments  (diastase,  sal- 
iva, pancreatic  juice,  &c.) 

solution  of  nitric  acid,  and  by  means  of  a 
camel-hair  pencil  paint  a  strip  across  the 
bandage  at  the  most  desirable  point  for 
division.  The  acid  will  so  soften  the  plaster 
that  it  may  be  readily  divided  by  means  of  an 
ordinary  jack-knife. —  Nashville  Journal  of 
Medicine  and  Surgery. 

Dr.  I.  Rabitsch,  of  Cairo,  in  the  Wien.  Med. 

Pidwifieiif. 

Woch.  speaks  very   highly  of  a  ten  per  cent, 
solution   of  salicylic    acid   in  forty  per  cent, 
alcohol  for  the  treatment  of  psoriasis,  eczema, 
and  especially  the  different  varieties  of  tinese. 
He  records  a  number  of  cases,  and  claims  that 
it  is  an  excellent  parasiticide. 

M.  Budin  considers  that  the  present  theories 
which  make  the  abdominal  walls  play  the  prin- 
cipal role  in  the  engagement  of  the  foetal  parts 
during  the  latter  weeks  of  gestation,  should  not 
be  accepted  without  question.  He  has  been  iu 
the  habit  of  teaching  that  the  muscular  fibres 

Mvqtv^. 

which  attach  the  uterus  to  the  pelvic  walls 
also  pay  an  important  part  in  determining  this 

Fracture    of    the    Astragalus.  —  At    a 

engagement. — L^  Union  Med. 

recent    meeting     of    the     Medico-Chirurgical 
Society,   of  Montreal,   Dr.  Shepherd,  Demon- 
strator of  Anatomy,   McGill    College,  read  a 
paper  on  a  hitherto  undescribed  fracture  of  this 
bone,   and  exhibited   three  specimens,   all   of 
which    wer€f   obtained    from    dissecting-room 
subjects.     The  portion  fractured  was  the  pro- 
cess external  to  the  groove  for  the  tendon  of 
the  flexor  longus  hallicis  muscle,  to  which  the 
posterior    fasciculus    of    the   external    lateral 
ligament  of  the  ankle-joint  was  attached.     Dr. 
Shepherd   thought  that   it  was   produced   by 
extreme  flexion  of  the  ankle  with  a  twist  of 
the  foot  outwards,  and  was  probably  one  of  the 
lesions  which  occurred  in  severe  sprain.     He 
suggested  that  it  might  account  for  some  of  the 
cases  of  severe  sprain  which  recovered  with 
impaired  movement  of  the  joint.     The  union 

The  Corpus  Luteum. — At  a  meeting  of  the 
Obstetrical  Society,  of  London,  Dr.  W.  A. 
Popoff,  of  Pensa,  read  a  paper  on  this  subject. 
In  it  he  described  the  case  of  a  prostitute, 
aged  21,  dying  of  prussic  acid  poisoning,  in 
which  he  found  a  fully  ripe  corpus  luteum, 
although  the  woman  was  neither  pregnant  nor 
menstruating.  The  President  (Dr.  Matthews 
Duncan)  said  it  was  important  to  have  the 
view  confirmed  that  a  corpus  luteum,  having 
all  the  characteristics  of  that  met  with  in 
pregnancy  occurred  in  women  who  were 
neither  pregnant  nor  menstruating.  He  had 
seen  such  a  corpus  luteum  in  an  aged  woman 
who  was  believed  to  be  salacious,  and  he  had 
dissected  cases  of  pregnancy  with  complete 
absence  of  corpus  luteum. 

232 


CANADIAN  JOURNAL 


C^omjsiponclnja. 


To  the  Editor  of  the  Canadian  Journal  or  Hbdical  Sciinob. 

Sir, — In  the  report  of  a  "  Case  of  (so-called) 
Tropical  Abscess  of  Liver,"  published  in  your 
last  issue,  it  is  stated  that  a  subsequent 
examination  of  the  patient  was  made  in  the 
"  presence  of  Dr.  Canniff,"  «kc.  Your  readers 
would  naturally  infer  that  I  was  present  as  a 
friend  of  the  family,  or  from  curiosity.  I  am  not 
In  the  habit  of  trying  to  advertise  myself  by  in- 
viting professional  or  non-professional  friends 
to  see  extraordinary  cases  I  may  have  under  my 
care,  nor  of  being  "present"  at  examinations 
or  operations,  unless  in  a  professional  capacity. 
In  this  case  I  was  asked  by  the  family  of  Mr. 
B.  to  meet  Dr.  Aikins  in  consultation,  who  had 
called  in  Dr.  H.  H.  Wright.  I  was  in  consul- 
tation for  four  days,  and  was  equally  responsi- 
ble with  those  gentlemen  in  making  a  diagnosis, 
and  in  determining  the  course  of  treatment  to 
be  pursued. 

Respectfully  yours,  "Wm.  Canniff. 

Toronto,  13th  June,  1882. 

[We  are  sorry  that  Dr.  Canniff  has  suggested 
such  an  interpretation,  as  Dr.  Cameron  wrote 
out  the  report,  and  the  possibility  of  this 
miscontruction  would  never  have  otherwise 
occurred  to  him. — Ed.] 


To  the  Editor  of  the  Canadian  JonsNAb  or  Mkdical  Scikicb. 

Sir, — During  the  last  year  I  have  read  a 
great  deal  in  your  valuable  Journal  about  Dr. 
Bray's  "  inexpensive  "  method  of  examining  a 
certain  Dr.  C?)  John  Hall,  Homoeopath,  of 
Toronto.  What  does  it  all  mean  ?  I  have 
never  seen  anything  in  the  act  which  provides 
fur  "  inexpensive,"  or  any  other  method  of  ex- 
amination before  the  Medical  Council  than  the 
one  specified  therein.  If  I  am  correct,  (and  I 
think  I  am)  the  expense  for  "Jinal  examination 
inchiding  registration"  is  $30  00,  I,  therefore, 
cannot  see  where  the  "  inexpensive  "  comes  in, 
when  the  said  Dr.  (/)  Hall's  father  paid  $20.00 
eoAih,  to  at  least  five  members  of  the  Council, 
after  the  said  examination  was  over,  which  was 
really  only  a  nominal  one,  and  not  a  test  of 
professional  qualification,  which  /  suppose  an 
examination    to   be   intended   for.     Was  this 


$20.00  (each)  transaction,  an  understood  thing 
before  the  "  examination "  ?  I  have  my  in- 
formation from  one  of  the  $20.00  recipients 
himself,  a  Homcepath,  consequently  it  is  very 
likely  true,  and  if  the  council  requires  his  name 
for  the  purpose  of  investigating  the  matter  I 
will  give  it.  Did  each  and  every  member  of 
the  council,  who  voted  for  Dr.  Bray's  "  in- 
expensive "  motion  and  against  Dr.  Wright's 
p*-otective  one,  receive  the  same  amount  1  If 
so,  /  would  consider  it  a  very  expensive  method. 
Again,  how  did  Dr.  Bratton,  late  of  London, 
Ontario,  become  registered  a  few  years  ago  1 
It  is  well  known  in  London  that  he  did  not 
comply  with  the  requirements  of  the  law.  Is 
there  much  of  this  kind  of  work  going  on  in 
the  council  t  If  so,  it  is  very  unjust  to  the 
profession  generally,  and  not  very  creditable  to 
the  Medical  Council  of  Ontario,  while,  at  the 
same  time  we  condemn  the  acts  of  the  no' oriou^s 
Buclianan  of  United  States'  fame  and  his  very 
learned  "  graduates  "  {?).  Is  anything  ever  to  be 
done  with  these  Buchanan  "gentlemen"  1 
They  are  each  and  every  one  of  them  guilty  of 
violating  the  law  by  securing  "  registration  " 
by  misrepresentation,  (in  act  or  word)  or  in 
very  plain  terms,  fraud,  for  they  know  how  they 
obtained  these  high  (?)  degrees  and  ju^t  how 
much  they  are  worth  (professionally  and  fin- 
ancially),  professionally,  nothing,  financially,  a 
great  deal.  Can  it  be  possible,  Mr.  Editor,  that 
money  can  purchase  medical  registration  in 
our  Ontario  1  Have  the  members  of  the 
Council  "sold  their  birthright  for  a  mess  of 
pottage  V  I  sincerely  hope  not.  Being  only  a 
country  practitioner,  and  living  a  long  way 
from  the  great  medical  centre,  I  (of  course)  am 
ignorant  of  many  council  and  other  matters 
professional,  but  having  been  a  very  long  time 
"in  harness,"  and  taking  a  great  interest  in 
every  thing  that  concerns  my  profession,  and 
more  especially  its  honor  and  integrity,  I  desire 
to  learn  and  know  all  I  can  regarding  its 
affairs.  I,  therefore,  write  you  for  information. 
Hoping  you  will  give  me  all  the  information 
which  I  have  asked  for,  and  that  you  will  ex- 
cuse the  length  of  this  letter. 

I  am  yours  truly, 

C.  W.  Flock,  M.D. 
Leamington,  June  9th,  1882, 


OF  MEDICAL  SCIENCE. 


233 


To  the  Editor  of  the  Canadian  Journal  of  Medical  Science. 

Dear  Mr.  EditoRj — In  giving  you  a  few 
notes  of  my  tour  I  shall  commence  with  Glas- 
gow. There  are  two  large  hospitals  in  that 
city,  the  Royal  Infirmary  and  the  Western 
Infirmary.  I  was  shown  through  the  former 
by  Dr.  White,  one  of  the  resident  physicians ;  I 
was  ve.y  much  interested  in  Dr.  McEwen'« 
cases  of  osteotomy.  There  were  about  thirty 
of  them  in  the  wards ;  some  waiting  to  be 
operated  on ;  some  lying  in  bed  on  whom  the 
operation  had  been  performed;  and  others  again 
walking  about  the  wards,  exhibiting  the  suc- 
cess of  the  treatment.  In  most  of  the  cases, 
the  operation  was  made  for  deformities  of  the 
lower  extremities,  the  results  of  rickets. 

I  was  told  by  the  house  surgeon  that  five  or 
even  more  operations  had  been  made  on  the 
one  patient.      They  are  performed  under  car- 
bolic  spray,  and  the   wounds  are  dressed  anti- 
septically.     The  resident  surgeon  also  told  me 
that  during  his  term  of  service  there  had  been 
no  unfavourable  results,  and  in  many  the  tem- 
perature did  not  rise  above  a  hundred  degrees. 
This  is  the  more  remarkaWe,  when  one  con- 
siders what  misei'able  constitutions  the  patients 
frequently  have.  The  success  of  the  treatment,  as 
exhibited  in  some  of  the  cases  was  very  marked 
indeed,  and  it  must  be  a  great  source  of  grati- 
fication to  Dr.  McEwen  to  have  instituted  a 
method  whereby  so  many  are  cured  of  what 
were  previously  considered  to  be  hopeless  de- 
formities.    It  would  seem  at  first  rather  ven- 
turesome to  produce  two  or  three  compound 
fractures  in  a  patient  at  one  time,  for  that  is 
what  osteotomy  really  amounts  to,  but  experi- 
ence has  shown  the  proceedure  to  be  a  very  sate 
one.     It  is  often  said  that  surrounding  circum- 
stances   frequently    develop     men    of     great 
achievements.      This  might  be  said    of    Dr. 
McEwen  as  I  have  never  seen  so   many  de- 
formed ricketty  children  in  my  life  as  I  saw  on 
the  streets  of  Glasgow  during  my  short  visit. 
If  any  one  could  give  a  method  whereby  these 
deformities  could  be  prevented,  he  would  prove 
even  a  greater  benefactor  to  the  human  race 
than  Dr.  McEwen. 

The  Royal  Infirmary  wUl  accommodate  six 
hundred  patients,  and  although  the  building  is 
old  the  wards  are  kept  very  clean  and  in  good 
order. 


The  Western  lufirmaiy,  a  beautiful  struc- 
ture, was  erected  about  eight  years  ago.  In 
going  through  this,  as  well  as  the  Infirmary  at 
Edinburgh,  one  is  struck  with  the  great 
liberality  of  a  people  who  would  willingly 
spend  so  much  for  their  suffering  fellow-beings. 
It  is  an  example  which  it  would  be  well  for  us 
more  and  more  to  imitate.  I  regret  that  I  was 
not  shown  through  this  Institution  by  any  of 
the  medical  staff,  as  it  was  not  the  hour  for 
visiting.  In  both  hospitals  the  members  of  the 
staff  attend  at  9  a.ra.  and  remain  until  10  or 
10.30.  They  are  very  punctual,  which  is  a  matter 
of  great  advantage  both  to  the  inmates  and 
students.  Glasgow  presents  great  facilities  for 
clinical  study,  both  on  account  of  the  size 
of  the  city  and  the  number  of  the  poorer 
classes ;  but  the  system  of  instruction  does  not 
appear  to  be  one  which  attracts  many  students 
from  a  distance. 

Edinburgh  as  a  place  for  medical  study  is 
very  far  ahead  of  my  expectation.  There  are 
here  five  medical  schools,  the  two  largest  being 
the  one  connected  with  the  University,  and 
the  College  at  Minto  House.  I  am  told  that 
there  are  over  fifteen  hundred  medical  stu- 
dents here.  The  Royal  Infirmary,  a  noble 
building,  is  in  my  opinion  superior  to  any 
similar  institution  which  I  have  visited,  not  ex- 
cluding the  New  York  Hospital  or  St.  Thomas's* 
London.  The  clinical  teaching  appears  to  be 
of  three  kinds  :  (1)  regular  clinical  lectures 
gi/en  in  the  amphitheatre;  (2)  ordinary  bed- 
side instruction,  which  is  given  in  a  very 
thorough  and  systematic  manner;  (3)  by  what 
is  called  history  reading.  One  of  the  clinical 
clerks  reads  the  history  of  a  case,  after  which 
the  teacher  corrects  parts  which  need  correc- 
tions, and  gives  a  short  clinic  on  the  particu- 
lar disease  present.  The  number  of  clinical 
clerks  which  a  lecturer  may  have  appears  to 
be  unlimited.  I  had  the  pleasure  of  hearing 
Dr.  Grainger  Stewart  give  a  clinical  lecture 
on  ascites.  The  patient  was  brought  in  from 
the  ward  on  a  stretcher  made  in  the  form  of  a 
long  basket,  which  was  rolled  along  on  small 
wheels.  The  shape  of  the  basket  prevented 
the  clothes  from  falling  off  and  the  patient 
in  this  way  getting  cold. 

Another  point  in  hospital  management  which 
I  noticed,  both  here  and  in  Glasgow,  was  that 


234 


CANADIAN  JOURNAL 


the  food  (for  dinner)  was  brought  up  to  the 
wards  from  the  kitchen  in  large  copper  pans 
with  double  bottoms,  the  space  between  the 
bottoms  being  filled  with  hot  water  and  the 
food  in  this  way  kept  warm. 

I  do  not  know  whether  any  improvement 
of  this  kind  has  lately  been  made  in  the 
Toronto  Hospital  or  not.  Formerly  the  pa- 
tients complained  very  much  of  the  food 
being  brought  up  cold. 

The  subject  of  pathology,  including  patholo- 
gical histology,  now  receives  a  large  amount 
of  attention  in  Edinburgh.  Two  hours  a 
day  are  given  by  Dr.  Hamilton  on  the  latter 
subject.  The  sectio'  s  already  made  by  the 
microtome  are  passed  around  to  the  class. 
Each  member  takes  one  and  mounts  it  while 
the  teacher  is  explaining  the  structure  by  black- 
board illustrations.  In  this  way  two  sections 
are  mounted  by  each  student,  during  the  time. 

In  the  post-mortem  room  I  saw  an  examina- 
tion made  on  one  of  those  peculiar  cases  of 
idiopathic  ansemia  in  which  there  was  degene- 
ration of  the  supra  renal  capsule  without 
bronzing  of  the  skin.  I  was  told  by  Dr. 
Hamilton  that  he  had  frequently  made  post- 
mortem examinations  on  cases  of  so-called 
idiopathic  ansemia,  but  that  so  far  he  had 
arrived  at  no  definite  conclusion  as  to  their 
pathology.  Dr.  Greenfield,  the  new  lecturer  on 
pathology,  I  regret  I  did  not  hear. 

I  was  very  much  surprised  on  seeing  the 
notices  for  clinical  lectures,  as  well  as  those  for 
courses  of  private  instruction  posted  on  the 
wall  on  one  of  the  public  streets.  One  can  see 
similar  notices  in  the  windows  of  many  of  the 
principal  drug  stores.  The  latter  method  is 
very  similar  to  the  manner  in  which  star 
actors  and  leading  concert  singers  announce 
their  appearance.  It  is  a  quiet  and  excellent 
way  of  advertising  specialties  as  the  public  can 
at  once  find  out  who  treats  diseases  of  the  eye, 
ear,  throat,  skin,  <fec.,  with  the  greatest  skill. 
I  am  afraid,  however,  it  would  not  be  allowed 
by  our  American  code  of  ethics,  in  fact  if  I 
remember  one  of  our  own  brethren  was  some- 
what censured  by  yourself,  for  in  this  way 
announcing  his  removal  from  one  house  to 
another.  We  will  look  more  leniently,  per- 
haps, on  these  mistakes  when  we  consider  that 


the  Physician-in-Ordinary  to  the  Queen  in 
Scotland,  is  announced  by  posters  to  lecture  in 
the  Royal  Infirmary,  at  such  and  such  an  hour 
each  day,  on  clinical  medicine.  The  same 
mode  of  advertising  is  adopted  by  a  medical 
school  in  Glasgow.  In  my  humble  opinion  all 
such  methods  should  be  condemned. 

The  new  Medical  School  connected  with  the 
University,  now  in  course  of  erection,  is  a  mag- 
nificent structure.  The  dissecting-room  is  over 
a  hundred  feet  long  and  three  hundred  students 
can  work  in  it  at  one  time. 

As  to  new  points  of  treatment  I  have  not 
observed  much.  In  the  Glasgow  Infirmary 
two  or  three  cases  of  locomoter  ataxia  were 
shown,  in  which  nerve  stretching  had  been 
done.  One  of  the  patients  was  considerably 
improved.  In  the  same  hospital  was  a  case  of 
psoriasis,  in  which  the  internal  administration  of 
chrysophanic  acid  had  been  adopted,and  no  local 
ti"eatment  used. 

There  was  decided  improvement  shown.  The 
medicine  was  given  at  first  in  half-grain  doses, 
in  pill  form  four  times  a  day.  The  dose  had 
been  increased  gradually  to  two  grains.  At 
different  times  the  stomach  rebelled,  but  after- 
wards became  tolerant  of  the  remedy.  In 
Edinburgh,  as  in  very  many  medical  schools, 
the  subject  taught  as  clinical  medicine  is  in 
reality  medical  diagnosis,  little  attention  being 
paid  to  special  treatment.  This  is,  perhaps,  the 
correct  way,  as  a  student  can  only  be  taught 
the  general  principles  of  treatment.  In  actual 
practico  one  has  to  so  large  an  extent  to  be 
guided  by  circumstances. 

One  point  worth  noticing  is  the  very  friendly 
way  in  which  the  diflferent  schools  arrange  the 
hours  for  clinics,  so  that  they  do  not  clash.  It 
confirmed  me  in  the  idea  that  we  should  perse- 
vere and  further  elaborate  the  system  which  was 
adopted  in  the  Toronto  Hospital  last  winter. 

J.  E.  Graham. 

Leipsig,  June  1st,  1882. 

The  Medical  Herald,  of  Louisville,  in  noting 
the  endeavour  to  obtain  a  chaiter  for  a  com- 
pany to  establish  a  cremating  furnace  in  Louis- 
ville, gives,  most  succinctly,  the  arguments  in 
favour  of  cremation,  and  disposes  of  the  ob- 
jections in  a  masterly  manner.  We  agree  with 
the  Herald  that  "intelligent  and  public-spirited 
citizens  should  aid  the  enterprise." 


OF  MEDICAL  SCIENCE. 


THE  CANADIAN 

jmiriiiij  of  Md'ml  hum, 

A  Monthly  Journal  of  Medical  Science,  Criticism, 
and  News- 

To  Correspondents. —  IVe  shall  be  glad  to  re- 
ceive from  onr  friends  everywhere,  current  meaical 
news  oj  general  interest.  Secretaries  of  Cottnty 
or  Territorial  medical  associations  will  oblige  by 
forwarding  reports  of  the  proceedings  of  their 
Associations. 

TORONTO,  JULY,  1882. 

THE  MEETING  OF  THE  ONTARIO 
MEDICAL  COUNCIL. 

The  recent  meeting  of  the  Council  was  upon 
the  whole,  the  most  satisfactory  ever  held  by 
that  body.  There  was  none  of  the  angry  dis- 
cussions, 01  petty  personal  conflicts,  which  often 
characterized  the  meetings  of  the  past.  In 
fact,  after  the  business  was  concluded,  there 
was  a  serious  consultation  between  some  of  the 
old  veterans  who  sighed  for  the  glories  of  the 
past,  and  other  ambitious  braves,  at  which  the 
opinion  was  freely  expressed  that  the  proceed- 
ings had  been  too  tame  entirely.  Notwithstand- 
ing the  disappointment  of  these  few  worthy 
individuals,  we  must  express  our  great  pleasure 
at  the  vast  improvement  shown  by  the  Council 
in  its  mode  of  conducting  the  ordinary  business 
of  this  session.  Every  question  which  came  up 
was  most  carefully  considered  before  any  de- 
cision was  reached,  and,  in  consequence,  there 
was  none  of  that  hasty  and  extraordinary  leg- 
islation, which,  in  some  former  years,  resulted 
in  numerous  astounding  and  indefensible  acts. 

Among  the  many  questions  considered,  one 
of  the  most  important  was  that  of  Examina- 
tions and  Examiners.  It  was  proposed  to  in- 
stitute a  change  requiring  yearly  examinations 
instead  of  the  primary  and  final,  as  demanded 
at  present ;  but  as  this  plan  had  been  tried 
before,  and  changed  only  two  years  ago,  it  was 
decided  to  make  no  alterations.  Without  dis- 
cussing the  merits  of  the  question,  we  think 
the  decision  a  wise  one,  as  frequent  changes  are, 
to  say  the  least,  useless,  and  at  the  same  time 
exceedingly  perplexing  and  harassing  to  the 
students.      The   Examining   Board   will   give 


general  satisfaction.  We  are  glad  no  sweeping 
or  radical  changes  were  made.  Six  of  the  old 
board  were  re-appointed,  and  three  new  ap- 
pointments were  made.  We  regret  exceedingly, 
however,  that  Dr.  Eccles,  who  was  one  of  the 
most  thorough,  careful,  and  eflB^cient  examiners 
the  Council  has  ever  had,  should  have  been  re- 
tained no  longer  than  the  miserable  term  of 
two  years.  The  appointments  of  the  former 
examiners  from  the  Toronto  Schools,  and  Dr. 
Cannifi"  in  Surgery,  are  highly  satisfactory. 
Dr.  Oliver,  of  Kingston,  is  not  well  known  here, 
but  the  fact  that  he  possesses  the  confidence  of 
his  colleagues,  should  be  a  sufficient  guarantee 
of  his  efficiency.  Dr.  Tye,  of  Chatham,  becomes 
an  examiner  for  the  third  consecutive  year  in 
the  same  subject.  Physiology.  This  is  one  of 
the  cases  where  the  Council  has  broken  through 
that  wretched  two-year  rule,  and  we  hope  he 
will  be  retained  for  seven  more  years.  As  to 
Dr.  Dickson,  appointed  a  second  year  in  Materia 
Medica,  eight  more  years  would  be  satisfactory. 
Dr.  Burdett  is  well  spoken  of  by  those  who 
know  him.  In  discussing  the  merits  of  different 
men  proposed  as  examiners  (sometimes,  by  the 
way,  a  very  delicate  matter)  there  was  evident 
on  the  part  of  the  majority  a  desire  to  choose 
men  eminently  qualified  for  the  various  posi- 
tions. Less  of  the  old  style  of  arguments  were 
advanced  such  as  :  "  There  hasn't  been  a  man 
from  my  division  for  some  time  ;  its  about  time 

you  give  us  a  chance,  there's  Dr.  ,  he's  a 

first-rate  fellow,  besides  he  worked  hard  for  me 
in  my  election."  When  asked,  "  Well !  what 
subject  do  you  propose  him  for,"  the  answer 
was  frequently,  "  Oh,  anything  you  like !  I 
don't  think  he's  particular."  There  may  be  a  few 
universal  genii,  who  are  qualified  to  examine 
in  any  or  every  subject ;  they  are  seldom  found, 
however,  in  any  cpuntry  but  this. 

We  are  glad  to  notice  that  a  Committee  has 
been  appointed  to  sell  the  old  building  at  present 
occupied  by  the  Council,  buy  a  new  piece  of 
land,  and  erect  a  building  better  suited  for  its 
purposes  than  the  present  dilapidated  looking 
edifice.  As  this  property  is  supposed  to  be 
worth  from  eighteen  to  twenty  thousand  dollars, 
there  is  no  reason  why  a  commodious  and  suit- 
able building  should  not  be  erected  in  a  locality 
sufficiently  convenient  for  all  practical  purposes. 


236 


CANADIAN  JOURNAL 


In  arranging  the  plans  we  hope  the  Committee 
will  keep  in  view  the  desirability  and  proba- 
bility of  establishing  a  museum  and  library  in 
the  near  future,  and  have  rooms  which  may  be 
used  for  these  purposes. 

Those  reading  an  account  of  the  meeting  will 
notice  Dr.  Playter's  plan  for  collecting  vital 
statistics.  As  it  is  founded  upon  the  principle 
of  paying  for  the  work  done,  even  though  that 
payment  be  very  small,  we  consider  it  the  most 
practicable  yet  proposed,  and  hope  the  Domin- 
ion Government  will  favourably  consider  the 
proposal. 

One  of  the  last  acts  of  the  Council  was  the 
appointment  of  a  Committee  to  seek  certain 
changes  in  the  Act  from  the  Legislature.  One 
of  the  most  important  required  is  conferring 
the  power  on  the  Council  of  taking  away  the 
license  from  any  party  who  is  found  guilty  of 
unprofessional  acts.  As  a  case  in  point,  we 
have  the  authority  of  the  President,  in  words 
publicly  expressed,  that  some  despicable  mortals, 
whD  unfortunately  are  legally  qualified  practi- 
tioners, are  actually  for  money  considerations 
giving  their  names  to  "  Drs.  K,  <fc  K."  of  De- 
troit, the  most  notorious  and  unscrupulous 
quacks  at  present  known  in  this  country,  to  be 
used  as  a  shield  against  the  just  penalties  of  the 
law.  We  cannot  help  sharing,  to  a  certain  ex- 
tent in  the  anxiety  of  those  who  have  heretofore 
objected  to  asking  any  amendments  to  the  act 
from  the  Legislature  through  the  fear  that  some- 
thing might  be  done  which  would  be  objection- 
able to  the  profession.  We  trust  that  the  present 
Committee  will  be  "  wise  as  serpents  and 
harmless  as  doves,"  and  if  they  are  unable  to 
accomplish  much  good,  we  hope  at  least  that 
they  may  do  no  harm.  All  will  be  glad  to 
know  a  new  Register  is  to  be  issued  shortly. 


Novel  Method  of  Suicide. — On  May 
26th,  Sarah  Newman,  in  the  Cork  Hospital 
for  Women  and  Children,  committed  suicide 
by  stuffing  her  stocking  down  her  throat,  so  firmly 
that  when  discovered  it  was  extricated  only 
with  great  difficulty.  It  was  done  so  quietly 
during  the  night,  that  the  occupants  of  the 
next  beds  were  totally  unaware  of  anything 
amiss  until  the  morning. 


THE  JUNE  MEETINGS. 

Three  representative  medical  associations 
met  in  June.  The  American  Medical  Associa- 
tion in  St.  Paul,  the  Ontario  Medical  Associa- 
tion in  Toronto,  and  the  Association  of  Asylum 
Superintendents  in  Cincinnati.  Other  associa- 
tions, such  as  the  Massachusetts  State,  the 
New  Jersey  State,  and  the  American  Surgical 
Society,  also  held  their  annual  meetings,  but  to 
these  it  is  not  our  present  purpose  to  refer. 
Of  each  of  the  three  first  named  we  have  heard 
it  said,  "  professionally  it  was  a  failure."  The 
American  Medical  Association,  however,  ac- 
complished one  good  deed  in  stamping,  with 
the  seal  of  professional  reprobation  and  execra- 
tion, the_ sprouting  libertinism  of  the  New  York 
Code.  By  a  unanimous  vote  the  Association 
declined  to  receive  the  delegates  from  the 
recalcitrant  State  Society.  We  trust,  and 
doubt  not,  that  a  similar  reception  awaits  those 
who  were  accredited  to  the  Canada  Medical 
Association.  Yet  another  proper  step  in  its 
own  interest  was  taken  by  the  American 
Association,  viz.,  the  decision  to  publish  a 
weekly  journal  instead  of  the  annual  volume 
of  transactions.  The  former  we  are  confident 
cannot  but  redound  to  its  credit  and  advantage, 
the  latter  we  are  no  less  sure  has  added  noth- 
ing to  its  prestige  or  reputation.  At  the 
Ontario  Association's  meeting  there  was  no 
dearth  of  papers,  but  they  were  not  at  all  up 
to  the  average  of  what  might  justly  be  expected. 
Discussion,  too,  was  jugulated  in  the  haste  to 
hear  them  all,  and  thus  the  salient  points  were 
not  duly  emphasised,  and  the  excrescences  of 
error  or  exaggeration  went  unworn  of  argument, 
unpolished  by  criticism.  The  Asylum  Super- 
intendents at  Cincinnati  not  unwisely  concen- 
trated their  energies  on  recreation,  and  enjoyed 
themselves  immensely.  Only  six  papers  were 
read  in  a  four  days'  session  ;  and  of  those  the 
best  was  probably  that  of  Dr.  R.  M.  Bucke,  of 
our  London  Asylum,  on  the  development  of  the 
intellect.  Even  of  this  a  Chicago  reporter  said 
it  was  too  metaphysical  to  be  intelligible. 
Thus  it  will  be  seen  that  the  summer  solstice 
has  not  proved  propitious  to  the  parturition  of 
professional  wisdom.  The  advent  of  Minerva  is 
not  yet,   since  of  these  three  chief  associations 


OF  MEDICAL  SCIENCE. 


237 


it  may  be  said,  "  Parturiunt  monies,  nascitur 
ridiculus   mus^ 

Let  the  members  of  the  Canada  Medical 
Association  see  to  it  that,  in  September,  they 
fall  not  into  like  condemnation.  The  Montreal 
men  have  always  been  the  mainstay — the 
backbone — of  this  Association.  They  have 
always  sent  a  fair  contingent  to  its  meetings ; 
and  these  have  ever  acquitted  themselves 
individually  creditably  and  well.  The  gauntlet 
of  past  achievement  lies  upon  the  ground,  and 
the  profession  in  Toronto  has  another  oppor- 
tunity to  enter  the  lists  and  pick  it  up.  In 
the  contest  of  honourable  emulation  and  worthy 
rivalry,  which  follows  issue  thus  fairly  joined 
we  need  not  despair,  but  with  an  equal  mind 
strive  manfully  for  the  victory.  Palmam  qui 
meruit  ferat,  say  we  all. 


OUR  COJSTTEMPOEARY. 

The  homoeopathic  organ  of  Toronto  thinks, 
or  affects  to  think,  that  thp  letter  of 
"  Junius,"  which  appeared  in  our  May  issue, 
was  our  own  production,  under  a  "  transparent 
no'in  de  plume."  We  take  pleasure  in  assuring 
our  friend  that  neither  the  letter  in  question, 
nor  any  other  letter  which  has  appeared  in  this 
Journal,  was  written  by  the  Editor  or  Editors. 
We  have  the  courage  of  our  convictions  in 
representing  the  Profession  of  this  country, 
and  will  never  stoop  to  any  such  cowardly 
subterfuge  in  expressing  our  views.  Our 
columns  are  always  open  to  any  respectable 
correspondents,  who  must,  of  course,  be  held 
responsible  for  the  opinions  they  express. 

As  to  "  Junius,"  we  may  say  that,  in  his 
letter,  he  either  did  not  know,  or  omitted  to 
mention,  the  principal  motive  which  inspired 
the  articles  in  the  Lancet  with  reference  to  the 
claims  of  the  Board  of  Health,  i.e.,  the  strong 
personal  enmity  shown  by  the  editor  of  the 
Lancet  towards  Dr.  Oldright  since  the  year 
1877,  which  arose  out  of  a  contest  for  the 
Senate  of  Toronto  University,  (in  which  the 
latter  committed  the  unpardonable  crime  of 
defeating  the  former  by  a  large  majority). 
This  is,  of  course,  a  purely  private  matter,  and 
no  business  of  ours,  and  we  are  only  sorry  in 
the  interest  of  journalism  and   the  professional 


public,  that  so  petty  a  matter  should  cause  an 
editor,  in  discussing  so  important  a  measure  as 
the  appointment  of  a  Board  of  Health,  to  make 
a  purely  personal  attack  on  any  member  of 
that  Board.  Without  doubt,  any  journalist 
descending  to  such  a  course  must  at  once  lose  all 
the  influence  his  writings  would  otherwise  exert. 

The  latest  reference  to  this  Journal  as  the 
"  organ  of  the  Toronto  School  of  Medicine  "  is 
somewhat  touching.  It  brings  us  back  to  the 
times  past  when  the  Canada  Lancet  with  its 
"largest  circulation,"  in  capital  letters,  fre- 
quently repeated,  was,  before  its  capture  by 
the  homoeopaths,  the  respectable  and  respected 
organ  of  the  Trinity  Medical  School.  We 
learn  with  grief  that  a  serious  difficulty  has 
arisen  which  slightly  complicates  matters.  It 
is  said  that  some  of  the  homoeopaths  object  to 
being  placed  in  a  false  position  by  being  asked 
to  consult  with  regulars,  who  do  not  believe  in 
their  peculiar  tenets,  and  with  whom,  therefore, 
they  can  have  no  common  ground.  If,  on 
these  considerations  they  repudiate  the  Lancet, 
its  prospects  become  gloomy  in  the  extreme,  and 
grave  fears  are  entertained  that  it  may  tumble 
into  the  "  deep  sea,"  and  be  nobody's  organ, 
except  the  proprietor's. 

We  dislike  to  contemplate  so  sad  a  picture, 
and  trust  that  a  much  brighter  future  is  in  store 
tor  that  Journal.  We  hope  the  Editor  will 
calmly,  deliberately,  and  dispassionately,  re- 
consider the  whole  question,  sincerely  repent 
his  evil  ways,  and  like  the  prodigal  of  old, 
return  to  the  bosom  of  his  numerous  former 
friends  in  the  Profession,  who  will  doubtless 
receive  him  with  open  arms  and  much  re- 
joicing. Although,  in  his  recently  accquired 
loss  of  vision,  he  accuses  us  of  "  bad  taste," 
still,  we  will  forget  it  .xU  and  gladly  join  our 
efforts  with  those  who  are  anxious  to  accom- 
plish a  result  so  happy,  but  apparently,  at 
present,  so  unlikely.  This  amblyopia  will,  per- 
haps, also  account  for  his  overlooking  the  letter 
of  "  Notandi  sunt  tibi  mores,"  which  we  inno- 
cently supposed  would  have  interested  him 
even  more  than  that  of  "  Junius." 


Dr.  H.  C.  Burritt,  of  Peterboro',  is  coming  to 
Toronto,  where  he  intends  to  locate  perman- 
ently and  engage  in  practice. 

Dr.  Halliday,  of  Grafton,  has  gone  to  Peter- 
boro'. 


238 


CANADIAN  JOURNAL 


BOARDS  OF  HEALTH. 

In  an  excellent  paper,  entitled  '•  Suggestions 
for  the  Reorganization  of  the  Sanitary  Service," 
read  before  the  Society  of  Medical  Officers  of 
Health,  of  Great  Britain,  by  Dr.E.F,  Willoughby, 
the  proper  constitution  of  a  Board  of  Health,  is 
thus  laid  down : — A  Vice-President  (subordi- 
nate only  to  the  President  of  the  Local  Gov- 
ernment Board,  or  Minister  of  Health),  always 
a  physician  chosen  for  his  special  knowledge 
and  administraiive  ability,  and  six  other  mem- 
bers, three  medical  men,  two  engineers,  and  one 
chemist.  The  suggestion  is  undoubtedly  a 
good  one ;  and  it  is  with  pleasure  we  have 
heard  of  the  possible  addition  to  our  Provin- 
cial Board,  of  Prof  John  Galbraith.  The 
further  addition  of  a  competent  and  able 
chemist,  would  approximate  our  Ontario  Board 
to  Dr.  Willoughby 's  ideal.  In  this  connection 
we  would  like  to  direct  the  attention  of  our 
contemporary,  the  Canada  Lancet,  to  the  fact 
that  association  in  such  matters  with  non-pro- 
fessional persons  is  quite  comme  il  faut,  as  the 
deliberations  of  such  Boards  in  no  sense  con- 
stitute a  medical  consultation.  Our  contem- 
porary is  guilty,  therefore,  of  an  egregious 
non  8eq^^^tur  when  he  endeavors  either  to 
derive  countenance  for  consultation  with  homoe- 
opaths from  the  presence  of  a  homoeopathic 
practitioner  on  our  Provincial  Board  of  Health, 
or  to  discredit  that  Board,  with  the  profession 
of  the  Province,  by  reiterated  allusions  to  the 
fact.  If  a  disciple  of  Hahnemann,  or  any 
other  unprofessional  man,  can  bring  any  light 
to  bear  upon  the  problems  of  sanitation  which 
await  solution,  let  him  speak,  and  the  true  dis- 
ciples of  Hippocrates  will  be  the  last  to  scorn 
his  information,  or  refuse  him  audience.  They 
will  not  readily  desert,  however,  the  substance 
for  the  shadow. 


We  are  much  obliged  to  Dr.  Talbot  Jones, 
of  St.  Paul,  for  copies  of  the  Daily  Pioneer 
Press  of  that  city,  containing  reports  of  the 
last  meeting  of  the  American  Medical  Associa- 
tion ;  and  only  regret  that  pressure  on  our 
space  prevents  us  making  as  much  use  of  them 
as  we  would  desire. 

Von   Langenbeck    has  resigned    in   Berlin. 


DEATHS  UNDER  ANESTHETICS. 

Two  deaths  from  anre^thetics  occurred  in 
Guy's  Hospital  in  one  week  during  the  month 
of  April.  The  first  was  caused  by  chloroform, 
which  was  administered  to  a  woman  set.  38, 
while  a  fracture  of  the  leg  was  being  reduced. 
The  heart  had  been  examined,  and  no  sign  of 
disease  discovered.  Post  mortem  examinations 
showed  lungs  healthy,  heart  surrounded  by 
adipose  tissue,  which  intruded  into  muscular 
substance  in  places,  liver  very  fatty,  kidneys 
slightly  fatty,  brain  wasted,  and  membranes 
thickened  (as  often  found  in  chronic  alcoholism.) 

The  second  death  was  caused  by  ether, 
which  was  administered  to  a  young  man  about 
to  be  operated  on  for  empyema.  When  under 
its  influence  he  was  rolled  on  sound  side,  when 
breathing  became  difficult,  pus  began  to  well 
out  of  mouth,  and  he  rapidly  died  apparently 
from  accumulation  of  pus  in  air  passages.  At 
post  mortem  examination,  in  addition  to  pus  in 
pleura,  numerous  fistulous  communications 
were  found  between  the  bronchi  and  the 
pleural  cavity.  The  British  Medical  Journal 
says  the  case  appears  to  furnish  a  warning  in 
relation  to  the  use  of  ether  during  operations 
for  empyema.  Ether  exerts  its  lethal  action 
first  on  respiration,  and  causes  greatly  in- 
creased accumulation  of  mucus  in  the  throat. 
Both  of  these  conditions  must  operate  un- 
favourably on  a  patient  already  deprived  of  all 
use  of  one  lung ;  and,  when  such  a  patient  is 
turned  on  the  healthy  side,  not  only  is  the 
action  of  the  lung  on  that  side  still  further 
embarrassed,  but  there  is  a  great  probability 
that  pus  will  find  its  way  by  fistulous  open- 
ings into  the  trachea,  as  occurred  in  this  case ; 
and  there,  partly  by  mechanical  action,  and 
partly  by  producing  spasm  of  the  glottis,  deter- 
mine a  fatal  asphyxia. 


PERSONALS. 

Dr.  Boyce  takes  Dr.  Halliday's  place  in 
Grafton, 

Dr.  McConnell  is  leaving  Thornhill,  Dr. 
Nelles  taking  bih  place. 

Drs.  W.  T.Aikinsand  Covernton,  of  Toronto, 
have  gone  to  England  for  a  trip. 


OF  MEDICAL  SCIENCE. 


239 


Professor  H.  I.  Bigelow  has  resigned  the 
Professorship  of  Surgery  in  Harvard  Univer- 
sity, after  having  been  connected  with  the 
school  for  thirty-three  years. 


DOCTORS  IN  THE  DOMINION 
ELECTIONS. 

At  the  recent  elections  there  were  ten  doc- 
tors elected  in  Ontario,  four  in  Quebec,  and 
three  in  Nova  Scotia,  viz.  : — 

Ont. — Dr.  Bergin,  Cornwall ;  Dr.  Hickey, 
Dundas ;  Dr.  Wilson,  E.  Elgin  ;  Dr.  Sproule, 
E.  Grey ;  Dr.  Landerkin,  S.  Grey  ;  Dr.  Fer- 
guson, Leeds  and  Grenville;  Dr.  Piatt,  Prince 
Edward  Co.  ;  Dr.  Ferguson,  Welland ;  Dr. 
Orton,  C.  Wellington  ;  Dr.  Springer,  S.  Went- 
worth.  Que. — Dr.  Lesage,  Dorchester  ;  Dr. 
Fortin,  Gaspe ;  Dr.  Blanchet,  Levis;  Dr.  De 
St.  Georges,  Portneuf.  N.  S. — Sir  C.  Tupper, 
Cumberland;  Dr.  Cameron,  Inverness;  Dr. 
Forbes,  Queen's. 

Among  the  unsuccessful  candidates  were 
Dr.  Sloan,  E.  Huron  ;  Dr.  Lamson,  E.  Kent 
Dr.  Sullivan,  Kingston ;  Dr.  McCallum,Monck 
Dr.  Sinclair,  N.  Norfolk;  Dr.  St.  Jean,  Ottawa 
Dr.  Fiset,  Rimouski ;  Dr.  Bethune,  Victoria, 
N.S. ;  Dr.  McLeod,  Cape  Breton.  Manitoba 
ar.d  British  Columbia  to  be  heard  from. 


The  Galvano  Cautery  in  Surgery. — We 
learn  from  some  remarks  recently  made  at  a 
meeting  of  the  Medical  and  Chirurgical  So- 
ciety of  London,  by  Dr.  Felix  Semon  that  the 
credit  of  the  introduction  ot  the  Galvano 
Cautery  in  Surgery,  usually  ascribed  to  Middel- 
dorpf,  of  Breslau,  is  in  reality  due  to  Mr.  John 
Marshall,  of  University  College,  the  President 
of  the  Society.  Mr.  Berkeley  Hill,  we  believe, 
deserves  the  credit  for  this  vindication  of  his 
countryman's  and  colleague's  merit. 


Prof.  Hueter,  of  Greifswald,  succumbed  to 
renal  disease  on  the  14th  of  May,  aged  44.  His 
latest  work,  Grundriss  der  Chirurgie,  is  only 
just  completed.  He  was  editor  of  the  Deutsche 
Zeitschrift  fur  Chirurgie,  and  the  author  of 
several  articles  in  Billroth 's  great  Handhuch  der 
Chirurgie. 


(^Wmx\t%. 


GEORGE  CAMPBELL,   M.D.,  LL.D. 

On  the  30th  of  May  last,  there  died  in  Edin- 
burgh one  whose  name,  for  the  last  half  century, 
has  been  associated  with  the  progress  of  the 
medical  profession  of  this  country. 

George  Campbell,  of  Roseneath,  Dumbarton- 
shire, a  Master  of  Arts  of  the  University  of 
Edinburgh,  and  a  Doctor  of  Medicine  of  that  of 
Glasgow,  came  to  Montreal  in  the  year  1835, 
having  been  urged  to  take  this  step  by  the 
advice  of  his  old  friend  and  tutor  the  late  Dr. 
Mathieson,  of  St.  Andrew's  Church,  Montreal. 
In  1835,  Montreal  was  a  very  small  town. 
Dr.  Campbell  took  up  his  residence  in  St. 
Gabriel  street,  close  to  the  river  bank,  and  with 
singular  good  fortune  at  once  took  a  leading 
position  in  the  pi-ofession,  as  well  as  in  general 
society.  In  this  same  year  commenced  his  con- 
nection with  McGill  College,  in  which  he  was 
appointed  Lecturer  on  Surgery  and  Midwifery. 
In  a  few  years  these  two  chairs  were  separated. 
Dr.  Campbell  retaining  the  former.  Thus  for 
a  period  of  forty-seven  years  Dr.  Campbell  was 
a  Professor  of  Surgery  in  this  Institution.  In 
1860  he  became  Dean  of  the  Medical  Faculty, 
a  position  he  held  with  honour  to  himself  and  to 
his  University  up  to  the  very  hour  of  his  death. 
His  term  of  active  service  as  surgeon  of  the 
Montreal  General  Hospital  extended  over  a 
period  of  thirty  years,  and  he  died  as  senior 
member  of  the  consulting  staff,  and  one  of  the 
Committee  of  Management. 

In  private  practice  Dr.  Campbell  enjoyed  the 
confidence  of  the  leading  families  of  Montreal ; 
and  to  a  great  extent  those  of  Canada  generally . 
Few  men  hare  ever  had  such  a  strong  hold  on 
the  affections  of  their  patients. 

Latterly  he  has  been  known  as  the  chief  con- 
sultant in  Montreal,  having  for  many  years 
declined  general  practice.  One  felt  certain 
that  in  applying  to  the  Dean,  "  the  old  Dean," 
as  he  was  often  afiectionately  called,  a 
good  honest,  common-sense  opinion  would  be 
obtained.  Many  a  young  practitioner  has  re- 
turned to  his  case,  encouraged  by  the  good 
advice,  and  the  kindly  word  of  the  man,  w  hom 
all  acknowledged  to  be  the  head  of  the  Cana- 
dian profession. 


340 


CANADIAN  JOURNAL 


The  writer  recalls  with  fond  recollection  the 
Dean's  coxirse  of  surgical  lectures,  the  bright 
wintry  mornings,  the  bluflf  old  gentleman  (for 
that  last  is  the  befitting  word),  always  neat, 
always  well-dressed,  bright,  and  cheery,  the 
sound  discourse,  a  trifle  old-fashioned  in  style, 
biit  in  subject-matter  up  to  the  times,  and  the 
droll  anecdote,  at  which  we  all  laughed. 

As  an  operating  surgeon  Dr.  Campbell  was 
pre-eminently  successful,  and  though  by  nature 
cautious  and  prudent,  he  was  not  one  to  h*  si- 
tate  at  a  dangerous  operation  when  a  life  was 
to  be  saved. 

In  1860,  he  ligatured  the  gluteal  artery  for 
traumatic  aneurism,  an  operation  *  up  to  that 
date  never  performed  successfully.  The  patient 
then,  a  lad  of  14,  is  now  a  well-known  citizen. 
In  the  journals  of  1845-55  are  to  be  found  re- 
cords of  some  of  his  capital  operations,  notably 
ligature  of  the  innominate,  and  of  the  external 
iliac  arteries. 

In  commerce  the  abilities  of  Dr.  Campbell 
were  well  recognized.  He  was  Vice-president 
of  the  Bank  of  Montreal,  and  director  of  several 
of  the  leading  joint  stock  companies  in  the 
country. 

Death  occurred  from  pneumonia,  contracted 
in  London,  England,  and  aggravated  by  the 
fatigue  of  a  journey  to  Edinburgh.  He  leaves 
a  widow  and  a  large  family.  His  only  son.  Dr. 
Lome  Campbell,  was  one  of  the  graduating 
class  of  the  Medical  Faculty  of  McGill  College, 
in  1882. 


Mr.  Spence,  Professor  of  Surgery  in  the 
University  of  Edinburgh,  died  on  the  7th  of 
June,  from  blood-poisoning,  supervening  on 
amputation  of  three  toes  for  gouty  inflamma- 
tion, at  the  age  of  70.  The  death,  on  1st  'une, 
of  Dr.  T.  B.  Peacock,  Physician  to  St.  Thomas's 
Hospital,  is  also  reported.  We  hope  to  publish 
a  brief  notice  of  these  distinguished  gentlemen 
in  our  next. 

*  "In  one  case  at  least,  the  gluteal  artery  has  been 
ligatured  with  success  (for  traumatic  aneurism),  just 
where  it  leaves  the  pelvis,  without  the  tumour  being 
opened.  This  was  in  the  practice  of  Prof.  Campbell,  of 
Montreal."  A  Manual  of  the  Operations  of  Surgery, 
by  Joseph  Bell,  Edin.  1866. 


Dr.  Arthur  H.  Hughes,  a  well-known  Cana- 
dian, died  in  Bombay,  Aj)ril  27th.  He  was 
born  in  Toronto,  in  1847,  was  a  student  of  the 
Toronto  School  of  Medicine,  and  graduated  in 
Toi'onto  University  in  1868.  He  then  went  to 
England,  and  receiving  his  commission  in  the 
Indian  Medical  Department  in  October,  1869, 
went  to  India  in  the  following  year.  In  1874 
he  took  up  his  residence  in  Bombay,  and  was 
posted  to  the  Jamsetjee  Jeejeebhoy  Hospital  in 
that  city.  He  was  subsequently  made  Prof,  of 
Midwifery  in  the  Grant  Medical  College,  in 
the  same  place,  and  held  the  professorship  to 
the  time  of  his  death.  He  soon  acquired  an 
extensive  practice  in  Bombay,  and  for  several 
years  was  honourary  surgeon-major  to  the  Bom- 
bay Voltinteers.  His  funeral  was  very  largely 
attended,  the  carrying  party  being  composed  of 
men  of  the  4th  (Royal  Lancaster)  Regiment, 
while  the  escort  was  formed  from  the  10th 
Native  Infantry.  The  cause  of  death  was 
pyaemia,  which  arose  from  a  slight  puncture  on 
the  hand  while  making  an  incision  for  the 
relief  of  a  patient,  about  a  fortnight  before  his 
own  demise.  The  dece;ised  was  a  nephew  of 
the  late  Dr.  Lawlor,  and  has  many  relatives 
residing  in  Toronto,  including  his  mother,  Mrs. 
Monaghan,  who  lives  on  BotTd  street. 


Sir  .'ohn  Rose  Cormack,  so  well  known  to 
British  residents  in  Paris  as  Chief  Physician  to 
the  Hertfoi'd  British  Hospital  in  that  city,  and 
as  Surgeon  in  Charge  of  Sir  Richard  Wallace's 
English  Ambulance  during  the  siege  and  Com- 
mune, diod  on  the  13th  of  May.  He  gradu- 
ated in  Edinburgh  in  1837;  was  some  time 
surgeon  to  the  Royal  Infirmary  there,  and 
founded  the  Edinburgh  Medical  Journal,  at 
that  time  familiarly  styled  "  Cormack's  'our- 
nal."  He  also  published  a  volume  of  "  Clinical 
Studies."  His  last  words,  addressed  to  Pro- 
fessor Ball,  his  j)hysician  and  fellow-country- 
man, were  characteristic  ot  the  man,  proving 
him  gladiator  in  word  as  well  as  deed  "  Mori- 
turi  te  aalutant." 

The  late  Dr.  James  Mcllraurray,  who  died 
June  10th,  was  one  of  Toronto's  oldest  prac- 
titioners. He  was  born  in  the  County  of 
Tyrone,  Ireland,  in  the  year  1800,  and  came  to 


OF  MEDICAL  SCIENCE. 


241 


this  city  in  1834,  where  lie  lived  up  to  the 
time  of  his  death.  About  two  years  ago  he 
retired  from  active  practice.  The  diseased 
gentleman  was  never  married.  He  was  a 
graduate  of  the  Royal  College  of  Surgeons, 
England,  and  was  very  successful  in  the 
practice  of  his  profession.  Dr.  Mcllmurray  was 
personally  very  popular  and  much  liked  by 
all  who  knew  him. 

The  Transactions  of  the  American  Medical 
Association  (instituted  1847),  vol.  XXXII. 
Philadelphia,  1881. 

We  regret  to  say  that  this  volume,  like  so 
many  of  its  predecessors,  is  quite  unworthy  of 
the  great  association  from  which  it  emanates. 
Some  of  the  papers  it  contains,  however,  are 
well  worthy  of  perusal ;  and  these  have,  for  the 
most  part  been  republished  during  the  year, 
and  have  been  referred  to  in  our  columns. 


The    Vest    Pocket    Anatomist    (founded    upon 
Gray.)    By  C.  Henri  Leonard,  A.M.,  M.  D. 
Eleventh  Revised  Edition.       Detroit:  The 
Illustrated  Medical  Journal  Company.   188fi. 
This  little  compend  is  just  what  it  pretends 
to  be ;    and   the   fact   of  having   reached   an 
eleventh    edition    is   an   evidence   that  many 
think  they  can  put  such  a  book  to  use.     On 
principle  we  are  opposed  to  all  such  publica- 
tions,  on    account    of    the  temptation    there 
exists  to  put  them  to  misuse. 


A  Manmcal  of  Obstetrics.  By  A.  F.  A.  Kino, 
M.D.,  Professor  of  Obstetrics  and  Diseases  of 
Women  and  Children,  Columbian  University, 
Washington,  etc. 

This  is  a  small  book  of  300  pages,  intended 
chiefly  for  the  use  of  students.  There  is  no  at- 
tempt at  originality,  but  all  the  essential  points 
are  taken  from  the  standard  works,  especially 
those  of  Lusk,  Playfair,  and  Leishman.  For 
an  epitome,  it  is  written  in  an  unusually  clear 
and  pleasant  style,  and  the  chapters  on  preg- 
nancy and  labour  include  everything  that  the 
student  is  accustomed  or  required  to  learn  for 
his  examinations.  It  is,  however,  like  all  the 
modem  abbreviations,  open  to  the  objection 
that  some  portions,  as  for  instance  the  descrip- 
tion of  the  cutting  operations  on  the  mothrr, 
are  so  brief  as  to  be  of  no  practical  use,  except 
for  cramming  purposes. 


gl^^tittyi8i  of  '#$ilifal  Miktit^. 


MEDICAL  COUNCIL  OF  ONTARIO. 

The  Annual  Meeting  of  the  Medical  Council 
commenced  on  Tuesday  afternoon,  June  13th, 
there  being  present  Drs.  Allison,  Bray,  Buchan, 
Burns,  Burritt,  Cranston,  Day,  Douglas,  Ed- 
wards, Geikie,  Henderson,  Husband,  Lavell, 
Logan,  McDonald,  McCammon,  McGargow, 
Rosebrugh,  Spragge,  Vernon,  Williams,  H.  H. 
Wright,  and  J.  W.  Wright. 

In  the  absence  of  Dr.  Bergin,  President,  the 
Registrar,  Dr.  Pyne,  presided.  Dr.  Bray 
was  elected  President  for  the  ensuing  year. 

The  following  officers  were  also  elected  : — 
Vice-President,  Dr.  Geikie  ;  R.  A.  Pyne, 
M.D.,  Registrar;  W.  T.  Aikins,  M.D.,  Treas- 
urer ;  Mr.  Dalton  McCarthy,  Solicitor.  Dr. 
Rosebrugh  took  his  seat  in  the  place  of  Dr. 
Brouse,  deceased. 

Dr.  Bray,  on  his  being  elected  to  the  Presi- 
dency of  the  Council,  thanked  the  members  for 
the  honour  conferred.  He  expressed  his  sense 
of  obligation  to  Dr.  Logan,  who  was  also 
nominated  for  the  position  of  President,  for 
retiring  in  his  favour,  and  in  conclusion 
thanked  them  all  for  the  honour  conferred  in 
being  elected  to  preside  over  the  deliberations 
of  such  an  intelligent  and  influential  body. 

STANDING  COMMITTEES. 

The  Council  then  proceeded  to  the  election 
of  Standing  Committees,  and,  on  motion  of 
Dr.  Lavell,  the  following  committee  was 
appointed  to  strike  the  Standing  Committees 
for  the  year : — Drs.  Day  (Chairman,)  Geikie, 
Logan,  Spragge,  Edwards,  and  Cranston.  After 
a  brief  consultation  they  reported  as  follows  : 

Committee  on  Registration — Drs.  Bergin, 
Rosebrugh,  J.  W.  Wright,  Vernon,  Buchan, 
Grant. 

Rules  and  Regulations — Drs.  Rosebrugh, 
Husband,  J.  W.  Wright,  Spragge,  and  Grant. 

Finance — Drs.  Edwards,  Allison,  McGargow, 
Day,  Henderson,  and  Douglas. 

Printing — Drs.  McCammon,  Vernon,  Bur- 
ritt, Morden,  and  Day. 

Education — Drs.  Lavell,  Geikie,  McCam- 
mon,   H.    H.    Wright,    McDonald,    Burritt, 


242 


CANADIAN  JOURNAL 


Logan,  Morden,  Williams,  Burns,  Cranston, 
and  Spragge. 

T)r.  H.  H.  Wright  gave  a  notice  of  motion 
to  the  effect  that  it  is  desirable  hereafter  that 
there  shall  be  examinations  annually  for  first, 
second,  and  third  year  students  respectively. 

A  lai'ge  number  of  petitions  were  received, 
and  referred  to  the  various  committees,  many 
of  them  being  from  students  who  had  failed  to 
pass  the  examination  in  particular  subjects. 
One  was  from  the  Maj'or  and  other  residents 
of  Amherstburg,  asking  that  a  license  or 
|>erniit  be  granted  to  Dr.  Daniel  Pearson,  who 
had  been  practising  for  thirty-three  yeai-a,  and 
who  had  previously  practised  in  the  United 
States  for  ten  years. 

The  Registrar  read  the  report  of  the  Board 
of  Examiners. 

The  President  gave  a  verbal  report  of  the 
proceedings  taken  by  the  detective,  whom  he 
had  appointed,  against  unlicensed  practitioners. 
One  of  these  was  Dr.  Kergan,  of  "  K.  »fc  K.," 
who  had  been  fined  $25  at  Petroleum.  K.  & 
K.  had  now  resorted  to  the  device  of  taking 
into  their  employment  regularly  licensed  On- 
tario practitioners,  and  he  regretted  that  they 
had  been  able- to  secure  the  services  of  a  con- 
siderable number.  Of  all  quacks  a  licensed 
quack  was  the  worst,  and  he  hoped  that  legis- 
lation would  be  introduced  to  deal  with  the 
matter. 

WEDNESDAY. 

The  Council  met  at  ten,  the  President,  Dr. 
Bray,  in  the  chair. 

After  the  minutes  had  been  adopted. 

Dr.  Lavell  gave  notice  of  a  motion  that  the 
assessment  to  be  levied  on  each  practitioner  for 
the  ensuing  year  be  $1  ;  also  of  a  motion  that 
the  registrar  be  instructed  to  send  out  circulars 
giving  notice  of  this  assessment. 

Dr.  Macdonald  gave  notice  of  a  motion  that 
it  is  necessary  to  issue  a  new  medical  register, 
and  the  registrar  be  instructed  to  do  so. 

Dr.  Day  gave  notice  of  a  motion  to  define 
the  manner  of  holding  elections,  to  define  what 
should  be  considered  residence  at  the  time  of 
election,  and  for  other  purposes. 

WILLIAM  smith's  CLAIM.        . 

A  letter  was  read  from  the  solicitor  of  Mr. 
William  Smith,  who  formerly  acted  as  detec- 


tive in  prosecuting  violatora  of  the  Medical 
Act,  reminding  the  Council  of  his  claim,  and 
offering  to  refer  it  to  arbitration. 

The  Registrar  said  that  ths  agreement  was 
that  Mr.  Smith  should  receive  $1,200  a  year, 
on  his  jiroducing  certificites  from  magistrates 
that  he  had  procured  convictions  to  that 
amount.  Certificates  had  been  presented  to 
the  amount  of  $675,  and  $600  had  been  paid 
to  Mr.  Smith.  Subsequently  he  had  procured  con- 
victions to  the  amount  of  $100.  The  registrar, 
however,  had  discovered  that  in  one  case  he 
had  acted  improperly,  which  he  was  advised 
invalidated  the  whole  claim. 

On  motion  of  Dr.  H.  H.  Wright  a  committee 
was  appointed  to  investigate  the  matter. 

Dr.  Geikie  presented  the  report  of  the  com- 
mittee appointed  to  draft  a  resolution  with  refer- 
ence to  the  death  of  the  late  Senator  B  rouse, 
and  moved  its  adoption.  The  following  is  the 
resolution  : — 

"  That  this  Council  leai-ned  with  the  sin- 
cerest  regret  the  death  of  their  late  colleague, 
the  Hon.  Senator  Brouse,  and  hereby  place  on 
record  th-;  very  high  regard  in  which  he  has 
always  been  held  by  his  associates  in  this 
Council.  In  the  death  of  this  gentleman  the 
Council  has  lost  an  able  associate  and  the  pro- 
fession of  medicine  one  of  its  most  distinguished 
members.  We  hereby  tender  to  his  bereaved 
family  our  heartiest  sympathy  in  their  bereave- 
ment." 

Dr.  Lavell  in  seconding  the  resolution  spoke 
feelingly  of  the  loss  which  the  Council  and  the 
profession  had  sustained. 

The  President  mentioned  the  work  which 
Dr.  Brouse  had  done  in  the  cause  of  sanitary 
science,  and  Dr.  H,  H.  Wright  gave  a  brief 
account  of  his  career. 

The  resolution  was  carried  by  a  standing 
vote. 

Dr.  Wright  moved  that  examinations  be 
held  annually  for  first  year,  second  year,  and 
third  year  students,  respectively,  and  that  the 
matter  be  referred  to  the  Education  Committee. 

Dr.  Allison  objected  to  the  multiplying  of 
examinations. 

Dr.  Geikie  thought  that  the  present  exam- 
inations were  sufficient  to  keep  the  students  to 
their  work. 


OF  MEDICAL  SCIENCE. 


243 


The  matter  was  referred  to  the  Education 
Committee. 

The  Council  then  adjourned  until  two  o'clock. 

AFTERNOON  SESSION. 

The  Council  met  at  2  p.m.,  and  after  routine 
business, 

Dr.  Burns  gave  notice  of  a  motion  for  the 
establishment  of  a  course  of  clinical  lectures  at 
the  Toronto  General  Hospital. 

Dr.  Day  gave  notice  of  motion  that  the 
treasurer's  statement  be  printed,  and  sent  to 
every  registered  practitioner  in  Ontario. 

Dr.  Wright  presented  the  report  of  the  com- 
mittee appointed  to  enquire  into  the  claim  of 
William  Smith,  reeommending  that  it  be  re- 
ferred to  the  solicitor  of  the  Council  for  further 
advice.     The  report  was  adopted. 

THE  NEW  REGISTER. 

Dr.  Macdonald  brought  up  the  motion  of 
which  he  had  given  notice  in  the  morning,  for 
the  preparation  of  a  new  register.  The  pres- 
ent one,  he  remarked,  was  now  seven  years 
old. 

After  some  discussion  as  to  what  the  register 
should  contain,  the  motion  was  carried,  and 
Drs.  H.  H.  Wiight,  Burns,  and  Geikie  were 
appointed  a  committee  to  assist  the  registrar  in 
the  work. 

On  motion  of  Dr.  Lavell,  the  by-law  to  pro- 
vide for  the  levying  of  an  annual  assessment 
was  read  a  second  time. 

Dr.  W.  T.  Aikins,  the  Treasurer,  read  his 
annual  report,  showing  that  the  balance  in  the 
bank  at  the  last  meeting  was  $2,011.14,  the 
fees  received  in  the  registrar's  office  $2,464.52, 
and  the  fees  from  candidates  $2,540,  making  a 
total  of  $7,015.66.  The  expenditure  left  a 
balance  of  $1,568.31.  Several  suggestions 
made  by  the  Treasurer  in  his  last  report  had 
been  acted  upon.  The  Execuuve  Committee, 
which  formerly  entailed  an  annual  expense  of 
about  $500,  had  not  met  during  the  year,  and 
the  services  of  the  detective,  employed  at  a 
salary  of  $1,200  per  year,  had  been  dispensed 
with,  notwithstanding  which  the  amount 
received  from  fines  was  in  excess  of  that 
received  last  year. 

An  increase  in  the  assessment  to  provide  for 


the  increasing  indebtedness  of  the  college  was 
recommended.  The  report  was  referred  to  the 
Committee  on  Finance. 

THURSDAY. 

The  Council  met  at  1 0. 30.  a.  m .  and  after  routine 
went  into  Committee  of  the  Whole  on  a  re- 
port of  the  committee  appointed  to  wait  upon 
the  Local  Legislature  for  the  purpose  of  pro- 
curing an  Act  to  amend  the  Ontario  Medical 
Act.  The  report  stated  that  in  consequence 
of  an  absurd  resolution  now  standing  on  the 
minutes  of  the  proceedings  of  this  Council,  and 
which  they  believe  to  have  been  there  by  mis. 
take,  they  had  been  unable  to  proceed.  They 
recommended  that  power  be  granted  them  to 
act  in  the  matter  as  contemplated  at  the  last 
meeting  of  the  Council.  The  occasion  of  the 
report  was  this.  At  the  last  annual  meeting 
of  the  Council  it  was  decided  to  apply  to  the 
Local  Legislature  to  have  the  Ontario  Medical 
Act  amended  so  as  to 

RE-ADJUST   THE    REPRESENTATION 

of  the  profession,  and  of  the  colleges  at  the 
Council.  At  the  same  meeting  an  amendment, 
directing  the  committee  to  get  the  opinion  of 
the  Superior  Court  judges  upon  the  Act,  was 
discussed,  and  according  to  the  minutes  carried. 
The  reason  this  resolution  was  referred  to  as 
absurd  was  that  it  annulled  the  previous 
motion. 

Dr.  Day,  veho  presented  the  report  of  the 
committee,  said  he  was  certain  that  the  reso- 
lution referred  to  did  not  carry.  Referring  to 
the  other  portion  of  the  report,  he  did  not 
share  in  the  feeling  that  the  Ontario  Parlia- 
ment would  not  grant  the  legislation  asked  for. 

Dr.  Macdonald  strongly  opposed  the  report. 

Dr.  Burns  thought  the  Council  should  look 
at  their  duty  to  their  constituents,  and  in  this 
view  there  were  unmistakable  signs  of  dissatis- 
faction among  the  profession  on  the  question 
of  representation.  He  contended  that  if  the 
Medical  Council  existed  for  the  public  pro- 
tection, it  should  fearlessly  approach  any  Legis- 
lature, no  matter  what  might  be  its  political 
stripe,  for  necessary  amendments  to  the  Act. 

Dr.  Bray  supported  the  report,  contending 
that  the  present  was  the  time  for  the  profes- 
sion to  make  itself  felt. 


244 


CANADIAN  JOURNAL 


Dr.  Williams  thought  that  the  Council 
should  be  unanimous  upon  the  nature  of  the 
changes  they  wanted. 

Dr.  Lavell  pointed  out  that  the  present 
scheme  of  representation  was  the  result  of  a 
compromise  between  the  colleges  and  the  dif- 
ferent branches  of  the  profession.  He  re- 
ferred to  the  difficulty  which  would  arise  in 
classifying  the  colleges  so  as  to  show  which 
should  be  entitled  to  representation.  He  sug- 
gested that  any  committee  which  might  be 
appointed  should  report  to  the  Council  before 
taking  any  action. 

Dr.  Burritt  thought  the  Council  should  not 
be  frightened  out  of  going  before  the  Legis- 
lature. 

Dr.  Geikie  thought  the  committee  should 
go  over  the  Act,  clause  by  clause,  and  see  what 
amendments  were  required. 

Dr.  H.  H.  Wright  moved  that  the  com- 
mittee rise  without  reporting.  The  motion 
was  lost,  and  the  report  was  afterwards 
adopted,  with  the  exception  of  the  word 
"  absurd,"  which  was  struck  out. 

The  report  of  the  Registration  Committee, 
dealing  with  a  number  of  applications  for  re- 
gistration, was  received  and  adopted. 

In  reference  to  the  claim  of  William  Smith, 
a  letter  was  received  from  the  solicitors  advis- 
ing the  Cjuncil  to  ask  for  particulars.  It  was 
decided  to  act  upon  the  advice. 

The  Council  then  adjourned,  and  some  of 
the  members,  on  the  invitation  of  Dr.  Aikins, 
visited  the  hospital  in  order  to  witness  an 
operation. 

AFTERNOON  SESSION. 

This  session  was  occupied  in  the  discussion 
of  a  proposition  to  sell  the  building  on  Bay 
and  Richmond  streets,  occupied  by  the  Council, 
a  resolution  to  that  effect  having  been  moved 
by  Dr.  Allison,  and  seconded  by  Dr.  Burns. 
It  was  generally  agreed  that  the  building  was 
not  a  suitable  one  for  the  college,  and  that 
it  could  be  sold  at  a  considerably  higher  price 
than  the  Council  paid  for  it.  The  idea  of  oc- 
cupying a  building  jointly  with  the  Ontario 
Board  of  Health  did  not  meet  with  much 
favour.  A  committee,  consisting  of  the  city 
members  and   Drs.    Allison   and   Macdonald, 


was  appointed  with  power  to  sell  if  they 
thought  advisable,  and  also  to  enquire  about 
a  site  for  a  new  building. 

FRIDAY. 

The  Council  met  at  10  a.  ni.  and  after 
routine,  went  into  Committee  of  the  Whole  to 
consider  the  report  of  the  Finance  Comnuttee> 
which  was  adopted.  The  report  showed  that 
the  arrears  of  fees  due  the  Council  were  $4,954, 
which  are  supposed  to  be  collectable.  The 
value  of  the  building  is  from  $18,000  to  $20, 
000,  and  there  is  a  mortage  of  $6,000  upon  ic. 
The  expenses  of  the  present  session  amount 
to  $1,985. 

Dr.  Macdonald  brought  before  the  Council 
the  following  plan,  proposed  by  Dr.  Playter, 
lor  collecting  disease  statistics. 

One  hundred  and  forty-four  observers  and 
reporters  of  prevailing  diseases  in  the  localities 
of  the  respective  observers,  medical  prac- 
titioners, of  several  years  standing,  to  be  ap- 
pointed by  the  Federal  Government,  and  dis- 
tributed as  follows  :  To  British  Columbia  2  ; 
Manitoba  and  N.  W.  Territories  2  ;  Prince 
Edward  Island  4  ;  New  Brunswick  1 1  ;  Nova 
Scotia  14  ;  Quebec  46  ;  Ontario  65  ;  Total  144  ; 
giving  one  observer  to  about  every  30,000  of 
the  population  in  each  Province. 

Each  observer  to  be  supplied  with  a  suffic- 
ient number  of  blank  forms  and  addressed  en- 
velopes. 

A  blank  to  be  filled  in  by  each  observer 
every  week,  Saturday  evening  if  possible,  from 
observers  day-book  and  memory  of  observations 
of  diseases  during  the  last  week,  to  the  best 
of  his  knowledge,  and  at  once  mailed — time 
occupied  with  each  report  not  more  than  from 
16  to  30  minutes. 

Each  observer  to  be  paid  by  the  Federal 
Government  $25,  for  the  52  reports,  or  for 
the  year,  occupying,  for  the  whole  number, 
from  13  to  26  hours  of  time — Total  cost  $3,- 
600. 

Number  of  observers,  and  their  remuner- 
ation, to  be  increased  if  possible,  as  the  advan- 
tages of  registration  become  apparent  and  more 
generally  known. 

At  a  central  office  or  bureau  at  Ottawa  tlie 
collected  reports  to  be  studied   and  compiled 


OF  MEDICAL  SCIENCE. 


245 


and  the  results  to  be  published  weekly,  as  soon, 
as  possible  after  receipt  of  reports,  in  some 
practical  form,  as  a  bulletin,  and  distributed  in 
large  numbers  throughout  the  Dominion,  to 
health  officers,  the  local  papers,  <fec.  &c. 

In  Ontario,  to  be  one  observer  in  each  of 
the  37  county  towns,  which  for  the  most  part 
are  central,  and  well  situated  for  such  a  pur- 
pose. Toronto  with  its  many  suburbs  might 
have  two  observers.  The  other  27  to  be 
located  in  the  larger  counties,  and  on 
railways,  with  ready  mailing  facilities.  Thus 
no  part  of  the  well  settled  portion  of  the 
province  need  be  more  than  from  12  to  15 
miles  (air  line)  from  an  observer. 

Observers  to  be  distributed  in  a  similar  way 
in  the  other  provinces. 

Dr.  Macdonald  moved,  and  Dr.  Burritt 
seconded,  a  motion  approving  of  the  plan, 
which  was  carried. 

The  Council  then  adjourned  until  two  p.m. 

AFTERNOON  SESSION. 

After  adjournment.  Dr.  La  veil  presented 
the  report  of  the  Education  Committee,  upon 
which  the  Council  went  into  Committee  9f  the 
Whole,  Dr.  Douglas  in  the  chair.  Most  of  the 
petitions  considered  by  the  committee  were 
refused,  the  principal  exception  being  in  the 
case  of  Dr.  W.  F.  Peters,  who  failed  by  a  very 
few  marks  in  surgical  anatomy  last  year,  and 
had  a  large  margin  on  other  subjects,  and  who 
is  now  living  at  Michipicoten  Island,  and  was 
accidentally  prevented  from  attending  the  ex- 
amination held  this  year. 

The  Committee  recommended  that  no  action 
be  taken  on  the  motion  of  Dr.  H.  H.  Wright 
regarding  annual  examinations  for  students, 
and  that  the  consideration  of  Dr.  Burns' 
motion,  as  to  clinical  lectures  at  the  hospital  be 
deferred  until  next  session. 

Several  changes  were  made  in  the  regula- 
tions governing  the  examination  of  students, 
the  most  important  of  which  were  a  clause  al- 
lowing candidates  who  had  paid  for  a  profess- 
ional examination  and  failed  to  pass  it  to  go 
up  for  one  subsequent  examination  without 
further  fee ;  and  an  instruction  to  examiners 
to  confine  their  questions  to  the  text-books  in 
common  use,  and  in  referring  to  diseases,  &c., 


to  use  the  names  most  commonly  in  use.  The 
clause  requiring  an  aggregate  of  320  was  ex- 
punged.    The  following 

BOARD    OF    EXAMINERS. 

was  appointed  : — Descriptive  anatomy,  Dr. 
Fulton,  Toronto  ;  theory  and  practice  of  med- 
icine and  general  pathology.  Dr.  A.  S.  Oliver. 
Kingston ;  midwifery,  operative  and  other 
than  operative,  with  puerperal  and  infantile 
diseases,  Di*.  Burdett,  Belleville ;  physiology 
and  histology.  Dr.  G.  A.  Tye,  Chatham ;  sur- 
gery, operative  and  other  than  operative,  med- 
ical and  surgical  anatomy.  Dr.  Canniff;  chem- 
istry, theoretical  and  practical,  toxicology,  and 
botany,  Dr.  W.  W.  Dickson,  Pembroke ;  med- 
ical jurisprudence  and  sanitary  science.  Dr.  W. 
Nichol,  Brantford ;  homoeopathy.  Dr.  H.  Field, 
Woodstock. 

Dr.  Douglas'  motion  regarding  a  uniform 
tarifi"  was  not  passed. 

A  vote  of  thanks  was  passed  to  Dr.  Bray, 
the  President,  who  briefly  replied,  to  Dr. 
Aikins,  Dr,  O'Reilly,  and  the  Toronto  Medical 
Society. 

After  the  minutes  had  been  read  the  Coun- 
cil adjourned  sine  die. 


ONTARIO   MEDICAL  ASSOCIATION. 

The  Second  Annual  Meeting  of  this  Associa- 
tion was  held,  Wednesday  and  Thursday,  June 
7th  and  8th,  in  the  Hall  of  the  College  of  Phy- 
sicians and  Surgeons,  Toronto,  the  President, 
Dr.  Covernton,  in  the  chair.  Among  those 
present  were  Dr.  Avery,  of  Michigan, 
and  Drs.  Fenwick,  Osier,  and  Shepherd,  of 
Montreal,  aa  visitors.  About  115  in  all 
attended  the  meeting. 

A   MUTUAL   BENEFIT  ASSOCIATION. 

A  letter  from  Dr.  Powell,  of  Ottawa,  was 
read  in  favour  of  the  formation  of  a  Mutual 
Benefit  Association  in  connection  with  the  medi- 
cal profession,  and  making  suggestions  as  to 
how  such  an  association  could  be  started  and 
conducted. 

It  was  resolved  to  refer  the  letter  to  the 
Committee  on  Papers,  so  that  they  might  report 
upon  it. 


246 


CANADIAN  JOURNAL 


THE    PRESIDENT  S   ADDRESS. 

The  President  then  delivered  his  annual  ad- 
dress. After  dwelling  upon  the  responsibility 
resting  upon  physicians  in  the  exercise  of 
their  profession,  and  cautioning  them  against 
being  too  rash  in  putting  into  practice 
the  sparkling  novelties  in  theories  that  were 
brought  forward,  he  gave  a  sketch  of  the 
work  already  done  by  the  Provincial  Board  of 
Health,  and  concluded  an  eloquent  and  instruc- 
tive oration  with  refex'ences  to  the  evidences  of 
scientific  progress. 

The  following  papers  were  read  in  general 
session,  Wednesday  and  Thuraday  :  On  "  Treat- 
ment of  Diphtheria,"  by  Dr.  Worthington,  of 
Clinton;  "Antiseptic  Treatment  of  Phthisis,"  by 
Dr.  Philip,  of  Brantford;  "Locomotor  Ataxia," 
with  exhibition  of  a  case,  by  Dr.  Stewart, 
Brucefield  ;  "  Concussion  of  the  Brain,"  by  Dr. 
Curry,  of  Rockwood  ;  "  Trachelorrhaphy,"  by 
Dr.  Temple,  Toronto ;  "  Haemorrhage  after 
Tonsillotomy,"  by  Dr.  Powell,  Edgar ;  "  Dis- 
locations of  the  Elbow  Joint,"  by  Dr.  Dupuis, 
Kingston  ;  "  Local  Boards  of  Health,"  by  Dr. 
Youmans,  Mount  Forest ;  "Alcohol  in  Disease," 
by  Dr.  Smith,  Sparta ;  "  Therapeutics  of  In- 
sanity," by  Dr.  Clark,  Toronto  Asylum; 
"  Points  in  the  Measurement  of  the  Lower  Ex- 
tremities," by  Dr.  Oldright,  Toronto  ;  Adenoma 
of  the  Vault  of  the  Pharynx,"  by  Dr.  Ryerson, 
Toronto  ;  "  Treatment  of  Diphtheria  by  Bibo- 
rate  of  Soda  and  Sulphur,"  by  Dr.  Ghent,  of 
Priceville  ;  "  Liquor  Calcis  in  Diphtheria,"  by 
Dr.  Mackelcan,  Hamilton ;  "  Eye  Hygiene  in 
Schools,"  by  Dr.  Palmer,  Toronto ;  "  Duties  of 
Coroners,"  by  Dr.  Riddell,  Toronto ;  "  Certain 
Diseases  of  Eye  and  their  Treatment,"  by  Dr. 
Rosebrugh,  Toronto.  The  number  was  too 
large  for  the  time,  and  as  a  consequence  in  the 
begining  there  was  manifested  too  much  haste  in 
getting  through  the  reading  of  papers  without 
discu.ssion  of  them.  We  hope  in  future 
issues,  to  give  some  of  the  papei-s  with 
accompanying  discussions'. 

ELECTION    OF    OFFICERS. 

The  Committee  on  Nominations  reported,  re- 
commending the  following  elections  for  the 
year.     The  report  was  adopted. 

President. — Dr.  Macdonald,  Hamilton. 


Ist  Vice-President. — Dr.  Stewart,  Brucefield. 

2nd  Vice-President. — Dr.  Daniel  Clarke, 
Toronto. 

3rd  Vice-President. — Dr.  Dupuis,  Kingston. 

4^th  Vice-President. — Dr.    Harrison,   Selkirk. 

General  Secretary. — Dr.  White,  Toronto. 

Treasurer. — Dr.  J.  E.  Graham,  Toronto. 

Corresponding  Secretaries. — Dr.  William 
Graham,  Brussels ;  Dr.  Burt,  Paris ;  Dr. 
Coburn,  Oshawa ;  Dr.  Mcintosh,  Vankleek 
Hill. 

Committee  on  Credentials. — Dr.  Beeman, 
Centreville  ;  Drs.  Burns  and  Pyne,  Toronto. 

Committee  on  Public  Health. — Drs.  Playter, 
Allison,  Oldright,  and  Youmans. 

Committee  on  Legislation. — Drs.  Spohn,Sloan, 
G.  Wright,  Covernton,  Mallow,  and  Macfar- 
lane. 

Committee  on  Publication. — Drs.  Cameron, 
Burns,  and  Fulton,  with  the  Secretary  and 
Treasurer. 

Committee  on  By-laws. — Drs.  A.  H.  Wright, 
Moore,  Tanner,  Cotton,  and  Bowlby. 

Committee  on  Medical  Ethics. — Drs.O'Reilly, 
McKelcan,  Carney,  C.  K.  Clarke,  and  Sinclair. 

The  following  resolutions  were  passed  : — This 
Association  approves  of  the  decision  of  the  Pro- 
vincial Board  of  Health  of  Ontario  to  co-operate, 
to  the  full  extent  of  its  powers,  with  the 
National  State  and  Local  Boards  of  Health  in 
the  United  States  and  in  the  Dominion  of 
Canada,  in  the  attempt  to  prevent  the  intro- 
duction and  spread  of  smallpox,  by  the  inspec- 
tion and  vaccination  of  immigrants,  and  the 
disinfection  of  their  baggage  and  clothing,  and 
by  notification  to  all  boards  of  health  interested 
of  the  entry  or  proposed  entry  within  their 
jurisdiction  of  immigrants  suspected  of  carrying 
with  them  the  germs  of  any  disease  dangerous 
to  the  public  health.  That  in  this  attempt  to 
lessen  the  spread  of  smallpox  and  other  com- 
municable diseases  on  this  continent,  it  is 
desirable,  that  all  health  officers,  and  boards  of 
health,  under  whatever  governmental  control, 
shall  earnestly  and  faithfully  co-operate,  and  to 
secure  this  co-operation  at  the  earliest  possible 
date,  we  bespeak  and  invite  the  individual 
efforts  of  every  member  of  this  Association. 

It  was  decided  to  hold  the  next  annual  meet- 
ing in  Toronto. 


OF  MEDICAL  SCIENCE. 


247 


Dr.  Canniff  moved,  "That  in  the  opinion  of 
this  Association  the  formation  of  a  medical 
library  and  museum  would  prove  beneficial  to 
the  profession  of  this  province,  and  that  the 
following  committee  be  appointed  to  consider 
the  feasibility  of  such  a  scheme,  to  report  to 
the  next  meeting : — Drs.  Cameron,  Holmes, 
Fulton,  Reeve,  Davidson,  Powell,  and  the 
mover."     Carried. 

Dr.  D.  Clarke  moved,  "  That  the  Secretary, 
Dr.  White,  receive  a  gratuity  of  $100  for 
his  valuable  services  during  the  past  year." 
Carried. 

The  president  elect.  Dr.  Macdonald,  was 
then  installed  and  made  an  appropriate  speech, 
thanking  the  Association  for  the  honour  con- 
ferred upon  him,  and  prophesying  a  brilliant 
future  for  the  organization. 

After  passing  some  formal  resolutions  the 
meeting  adjourned. 

Since  the  meeting  the  President  has  made  the 
following  nominations  to  the  temporary  com- 
mittees for  this  year  : — 

Surgery,  Pathology,  ami  Anatomy. — Drs. 
Canniff,  Oldright,  Strange,  Toronto ;  Powell, 
Edgar  ;  Groves,  Fergus  ;  Pnilip,  Brantford  ; 
Worthington,  Clinton;  Eckroyd,  Mount  Forest; 
Hunt,  Clarksburg ;  Leslie,  Hamilton ;  and ' 
T  lylor,  Goderich. 

Medicine,  Materia  Medica,  and  Physiology. — 
Drs.  Hamilton  and  Clemesha,  Port  Hope ; 
Mullen  and  Wallace,  Hamilton ;  Fulton, 
Cameron,  and  H.  H.  Wright,  Toronto;  Gil- 
lies, Teeswater ;  Clark,  Oshawa ;  McKay, 
Woodstock ;  Winskill,  Brantford  ;  McDonell, 
Brechin  ;  Metcalf,  Kingston ;  and  Morton, 
Wellesley. 

Obstetrics,  G'yncecology,  and  Jurisprudence. — 
Drs.  Rosebrugh,  Hamilton  ;  Bray,  Chatham  ; 
Burritt,  Peterboro' ;  Yeomans,  Mount  Forest ; 
Battersby,  Port  Dover  ;  Bowlby,  Berlin;  Hall, 
Meaford  ;  Dunlap,  Lowborough  ;  Hillary,  Au- 
rora ;  Gardiner,  London  ;  Holmes,  Chatham  . 
Trimble,  Queenstown;  Black,  TJxbridge  ; 
Thorburn,  Macdonald,  Ross,  sr.,  Pyne,  sr.,  and 
Temple,  Toronto. 

Ophthalmology  and  Otology. — Drs.  Reeve  and 
Palmer,  Toronto ;  Bonnar,  Albion ;  Baugh, 
Hamilton ;  Ryerson  and  Rosebrugh,  Toronto. 

Necrology. — Di-s.     Woolverton,    Hamilton  ; 


Ghent,  Priceville ;  Knight,  Tamworth  ;  Gunn, 
Durham ;  Kitchen,  St.  George ;  Riddel, 
Toronto  ;  McTavish,  Staffa  ;  James,  Burgess- 
ville  ;  and  Day,  of  Trenton. 

Audit. — Drs.  G.  Wright,  Robinson,  and 
Lett,  Toronto  ;  Tucker,  Orono  ;  Curry,  Rock- 
wood  ;  Mackelcan,  Hamilton  ;  Secord,  Bright; 
and  Bruce  Smith,  of  Sparta. 

Papers  and  Business.  —  Drs.  Workman, 
Sweetnam,  Machell,  W.  B.  Geikie,  McPhedran, 
Zimmerman,  and  King,  of  Toronto ;  Inksetter, 
Dundds  ;  Mullin,  Hamilton  ;  Allan,  Harris- 
ton  ;  Monroe,  Dominionville ;  Stalker,  Har- 
wich ;  and  Magill,  of  Oshawa. 

Committee  on  Arrangements. — Dr.  Bascom, 
TJxbridge  ;  Robinson,  Markham  ;  Buchan,  J. 
Ross,  jr.,  McFarlane,  Pyne,  jr.,  Duncan,  Smith, 
Nevitt,  Bryce,  Wagner,  and  McCulIough,  of 
Toronto. 


^xmWmmn. 


The  Vis  Medicatrix  Nature. — Dr.  Oliver 
Wendell  Holmes,  in  an  address  to  the  Medical 
Class  of  Harvard  College,  on  "  Medical  High- 
ways and  Byways "  {Bosto7i  Med.  and  Surg. 
Journal,  June  1,  1882),  wittily  said:  "What- 
ever other  theories  we  may  hold,  we  must 
recognize  a  vis  medicatrix  in  some  shape  or 
other.  *  le  le  pensay  et  Dieu  le  guarit '  (I 
dressed  his  wound  and  God  healed  it),  was  the 
saying  of  Ambroise  Pare,  which  you  may  read 
to-day  on  the  walls  of  the  lecture-room  of  the 
Ecole  de  M6decine  in  Paris.  The  operator 
amputates  a  limb  and  leaves  a  bleeding  wreck 
after  him.  What  surgeon  who  looks  on  the 
rounded  and  cushioned  stump  a  few  weeks 
later  can  help  owning 

'  There's  a  Divinity  that  shapes  our  ends. 
Rough  hew  them  how  we  will.'  " 


The  Medical  Student's  Primer. — What 
place  is  this  1  This  is  the  Pathological  Society. 
How  does  one  know  it  is  the  Pathological 
Society  1  You  know  it  by  its  specimens  and 
smells.  What  does  that  gentleman  say  1  He 
says  he  has  made  a  post-mortem.  All  the 
gentlemen  make  post-mortems.  They  would 
rather  make  a  post-mortem  than  go  to  a  party. 
What  is  that  on  the  plate  1      That  is  a  tumor. 


248 


CANADIAN  JOURNAL  OF  MEDICAL  SCIENCE. 


It  is  a  very  large  tumor.  It  weighs  one 
hundred  and  twelve  pounds.  The  patient 
weighed  eighty-eight  pounds.  Was  the  tumor 
removed  from  the  patient  1  No,  the  patient 
was  removed  from  the  tumor.  Did  they  save 
the  patient  1  No,  but  they  saved  the  tumor. 
What  is  this  in  the  bottle  1  It  is  a  tapeworm. 
It  is  a  long  tapeworm  ;  it  is  three  quarters  of 
a  mile  long.  Is  that  much  for  a  tapeworm  1 
It  is  indeed  ii  uch  for  a  tapeworm,  but  not 
much  for  the  Pathological  Society. — iV.  F. 
Medical  Record. 


In  a  curious  old  work,  published  in  1824, 
entitled  "  Nugse  Chirurgicse,"  by  Wm.  Wadd, 
Esq.,  F.  L.  S.,  we  find  the  following  account  of 
Cordus,  a  physician  of  eminence,  who  died  iu 
1535  : — "  Cordus  who  was  accustomed  to  re- 
ceive his  fees  only  at  the  termination  of  his 
patient's  disease,  describes  in  a  facetious  epi. 
gram,  the  practitioner  at  three  difierent  times, 
in  three  difierent  characters. 

Tres  medicus  facies  habet ;  unam,  quando  rogatur, 
Angelicam  ;  mox  est,  cum  juvat,  ipse  Deus. 
Post  ubi  curato,  poscit  sua  praemia,  morbo, 
Horribilis  apparet,  terribilisque  Sathan. 

"Three  faces  wears  the  doctor  ;  when  first  sought, 
An  angel's,  and  a  god's — the  cure  half  wrought : 
But,  when  that  cure  complete,  he  seeks  his  fee, 
The  devil  looks  then  less  terrible  than  he." 


Cricket. — In  an  interesting  lecture,  given  by 
Mr.  Frederick  Gale  on  the  13th  inst.,  at  the 
Marlborough  Rooms,  a  remarkable  instance  was 
given  of  the  longevity  of  cricketers.  This  was 
the  so-called  B  Eleven,  chosen  by  Lord  Fred- 
erick Beauclerc  to  play  against  All  England. 
Of  these  eleven  men  the  youngest  died  at  the 
age  of  sixty-nine,  while  the  others  succumbed 
between  that  age  and  ninety-five.  The  lecturer 
might  well  say  that  insurance  offices  would 
grow  rich  if  no  lives  but  those  of  cricketers 
were  taken.  Mr.  Gale  is  well  known  as  an 
enthu.='iastic  cricketer  ;  and  there  was  a  whole- 
some, honest  ring  in  his  lively  and  interesting 
discourse,  which  his  audience  (a  large  and  in- 
fluential one)  evidently  appreciated.  Professor 
Ruskin  occupied  the  chair.  The  importance  of 
cricket  upon  the   health   and  stamina  of  the 


nation  cannot  be  over-estimated  ;  and  we  trust 
that  enthusiasts  like  Mr.  Gale  may  never  be 
wanting  to  stir  up  the  rising  generation  to 
honourable  deeds  in  the  "  field,"  where,  accord- 
ing to  the  Ii'on  Duke,  the  Battle  of  Waterloo 
was  won. — Lancet. 


Singular  Suicide. — A  man,  after  a  dispute 
with  his  wife,  took  a  poignard,  10  centimetres 
in  length,  and  placing  it  vertically  upon  the 
top  of  his  head,  proceeded  to  drive  it  w  ith  a 
hammer  into  his  head  as  far  as  the  guard.  He 
did  not  die,  but  pi'eserved  his  intelligence, 
senses,  and  power  of  motion.  Becoming  anxious 
he  called  in  a  physician,  who  tried  in  vain  to 
remove  the  poignard.  Dr.  Dubrisay,  was 
called  in  to  assist.  The  efibrts  of  both  were 
still  unsuccessful.  They  fatigued  the  patient 
by  dragging  on  the  handle  of  the  piognard, 
solidly  fixed  in  the  cranial  walls,  but  it  did  not 
budge.  They  conducted  him  then  to  a  neigh- 
bouring workship  where  they  might  obtain 
suificiently  energetic  means  of  traction.  Placed 
^between  two  doors,  having  in  their  interval  a 
strong  pair  of  iron  forceps,  moved  by  mechani- 
cal force,  the  patient  was  seated  on  the  ground 
and  held  steady,  the  handle  of  the  poignard  was 
seized,  drawn  without  shock  and  pulled  out, 
lifting  up  the  patient  a  little  who  fell  back  upon 
the  ground.  He  got  up  at  once  and  began  to 
walk  and  talk,  led  M.  Dubrisay  to  his  caraiage 
and  thanked  him.  The  blade  of  the  instrument 
was  a  little  bent  at  the  point.  It  was  seen  that 
it  had  struck  against  some  hard  body  which 
was  the  occipital  fossa.  Fearing  the  super- 
vention of  meningitis,  the  patient  wss  taken  to 
the  Hospital  St.  Louis,  in  the  service  of  Mr. 
Pean,  but  he  went  out  in  eight  days  without 
t'le  appearance  of  any  inflammatory  or  paraly- 
tic accident. — Siecle  Medical — Le  Prog.  Med. 


MAHRIAaES. 

On  the  20th  inst,  at  the  residence  of  the  bride's 
father,  by  the  Rev.  S.  M.  Jackson,  assisted  by  the  Rev. 
Mr  Powis,  Dr.  W.  K.  D.  Sutherland,  of  Winnipeg,  to 
Nellie,  second  daughter  of  Dr.  Richardson,  Clover  Hill, 
Toronto. 


THE 


-^ 


Canabian  |0Hrttal  of  '§][£bical  ^ciemt 

A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


U.  OGDEN,  M.D., 

R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond., 


\  Consulting  Editors. 


A.  H.  WRIGHT,  B.A.,  M.B.,  M.R.C.S.,  Eng.,  lEdnor 
L  H.  CAMERON,  H.B.,  > 


(SUBSCRIPTION,    93    PER   ANNVin. 


SSS"  All  literary  communications  and  Exchanges  should  be  addressed  to  Dr.  CAMXBON,  273  Sherhoume  St.  ; 

or,  Dr.  WBiaHT,  313  Jarris  St. 
SS"  All  business  communications  and  remittances  should  be  addressed  to    HART  tt  COMPANY,  Publishers, 

31  and  33  King  Street,  Toronto. 


TORONTO,  AUGUST,  1882. 


TONSILLOTOMY  AND  ITS  COMPLICA- 
TION BY  HEMORRHAGE. 

DR.  N.  A.   POWELL,  EDGAR,  ONT. 
(Read  at  the  Meeting  of  the  Ontario  Medical  Association.\ 

A  three-fold  purpose  has  induced  me  to  pre- 
sent, at  this  meeting,  certain  jwints  regarding 
tonsillotomy  and  one  of  its  occasional  complica- 
tions. To  give  you  in  brief  a  history  of  the 
case  which  first  directed  my  attention  to  this 
subject,  to  bring  out  in  discussion  some  of  the 
experience  at  present  stowed  away  in  the  gray 
matter  of  the  cerebral  convolutions  of  the 
members  of  this  association,  and  with  such 
help  to  reach  sound  conclusions  as  to  what  the 
treatment  of  the  complication  in  question  should 
be,  have  been  the  objects  which  I  have  had  in 
view  in  the  preparation  of  this  paper. 

At  the  last  meeting  of  the  American  Laryn- 
gological  Association,  its  secretary,  Dr.  George 
M.  Lefferts,  of  New  York,  discussed  "  The 
Question  of  Haemorrhage  after  Tonsillotomy," 
and  classified  its  frequency  and  severity  thus  : — 

Ist.  A  fatal  hsemorrhage  is  very  rare. 

2nd.  A  dangerous  hsemorrhage  may  occur. 

3rd.  A  serious  one,  serious  as  regards  both 
possible,  immediate,  and  remote  results,  is  not 
very  unusual,  and 

4th.  A  moderate  one  requiring  direct  pres- 
sure, and  strong  astringents  to  check  it  is  com- 
monly met  with. 

Of  the  first  or  fatal  class,  the  reader  had  not 
been  unfortunate  enough  to  meet  with  an 
example. 

Other  surgeons  have,  however,  placed  on 
record    a   small    number   of  cases   fatal    from 


hsemorrhage  following  the  excision  of  the 
pharyngeal  tonsils,  while  a  much  larger  num- 
ber of  deaths  have  been  caused  by  the  loss  of 
blood  succeeding  operative  procedures,  other 
than  amputations,  in  the  tonsillar  region. 

Coming  within  the  second  class,  two  cases 
have  occurred  in  the  practice  of  Dr.  Lefferts 
from  a  total  of  about  500  operations.  Both  are 
recorded  in  his  paper.  The  history  of  the  first 
I  shall  read  to  you  since  I  am  able  from  the 
standpoint  of  the  patient  to  add  to  it  some- 
what. 

In  the  fall  of  1874,  while  attending  at 
Demilt  Dispensary,  the  throat-clinic,  held  on 
alternate  days  by  Drs.  Lefferts  and  McBurney, 
I  requested  the  former  to  remove  my  tonsils, 
as  they  were  subject  to  recurrent  attacks  of 
follicular  inflammation. 

I  give  you  in  his  language  what  then  oc- 
curred. 

"  I  amputated  both  excessively  hypertropUed 
tonsils  with  the  tonsil  bistoury.  My  incisions, 
I  may  say  here,  were  made  with  care,  and  were 
such  as  I  had  made  many  times  before,  in  other 
instances.  A  few  moments  after  the  operation, 
an  inspection  of  the  throat  having  shown  no 
excessive  bleeding,  I  left  the  dispensary  where 
the  operation  had  been  performed,  and  my 
patient,  who  was  using  an  ice- water  gargle.  I 
did  not  see  him  again  for  several  hours,  and  then 
found  him  almost  exsanguinated  and  pulseless. 
Profuse  bleeding  commenced  almost  immedi- 
ately upon  my  departure,  occurring  very  sud- 
denly. The  flow  was  so  rapid  that  the  patient 
could  not  clear  his  mouth  of  it.  Blood  passed 
into  the  stomach,  giving  rise  to  repeated  attacks 
of  vomiting,  and  into  the  .larynx,  causing 
strangulation.     As  described  to  me,  his   con- 


250 


CANADIAN  JOURNAL 


ilibiou  wuM  t'ui'  u  time  a  daiigeruus  oue.  All  chu 
resources  at  hand  at  the  moment  that  suggested 
themselves  to  the  doctors  present,  except  pros- 
sure,  wei'e  tried  without  avail.  The  hiiMiiorr- 
hage  persisted.  I  was  sent  for  but  not  found, 
and  finally  my  colleague,  Dr.  McBurney,  fortu- 
nately reached  the  case  some  three  hours  after 
the  commencement  of  the  Ideeding.  He  at 
once  did  what  should  have  been  done  before, 
cleared  all  blood  clot  out  of  pharynx,  differ- 
entiated the  source  of  the  haemorrhage,  and 
applied  direct  pressure  over  the  spot  on  the 
right  side  from  whence  it  was  found  to  come. 
In  a  short  time  it  had  ceased.  I  arrived  later, 
and  found  my  patient  stretched  upon  a  bench, 
as  I  have  said,  white,  bloodless,  and  almost 
pulseless.  After  an  anxious  night  spent  with 
him  where  he  lay,  he  was  carried  in  the  morn- 
ing to  his  home,  and  slowly  convalesced  during 
the  following  month.  There  was  at  no  time  a 
recurrence  of  the  bleeding." 

In  the  removal  of  the  right  tonsil,  the  one 
which  gave  rise  to  the  trouble  afterwards.  Dr. 
Lefferts  was  assisted  by  a  surgeon  who  hap- 
pened to  be  present.  Thi^  latter  gentleman 
held  the  vulsellum  forceps  in  order  to  free  Dr, 
L's  right  hand  for  the  use  of  the  bistoury. 

I  noticed  that  as  the  section  was  made  strong 
traction  was  also  made  upon  the  tonsil,  and 
this  must  have  placed  on  the  stretch  the  tissue 
last  divided,  which  was  the  lower  part  of  the 
gland.  In  this  part  lay  tlie  artery — probably 
the  tonsillar  branch  of  the  ascending  pharyn- 
geal— from  which  the  subsequent  bleeding 
occurred.  Its  mouth  opened  deeply  in  the 
sulcus,  between  the  tongue  and  the  stump  of  the 
tonsil,  and  it  was  so  obliquely  divided  that  the 
contriiction  and  retraction  by  which  natural 
hsemostasis  is  effected  could  not  take  placr. 
Possibly  this  vessel  was  enlarged  at  the  expense 
of  the  others  supi)l)'ing  the  gland,  possibly  also 
the  indurated  tissue  through  which  it  ran  pre- 
vented its  closure. 

About  half-an-hour  after  Dr.  Lefferts'  hurried 
departure  to  fill  his  next  engagement,  the  bleed- 
ing became  very  free.  I  then  asked  some  of 
the  physicians  from  other  departments  of  the 
dispensary  to  look  at  the  wound.  They  did  so 
and  one  prepared  for  me  a  tannic  acid  gargle 
as  advised   by  Mackenzie,   while  another  im- 


mediately after  its  use  applied  to  the  [>art  a 
solution  of  the  persulphate  of  iron  with  a 
brush. 

Between  them  they  filled  the  fauces  and 
pharynx  with  ink,  manufactured  on  the  spot, 
a  third  gentleman  then  began  giving  me  10 
grain  doses  of  quinine,  while  another  spoke 
rather  indefinitely  of  the  hypodermic  use  of 
ergotine  or  the  ligation  of  the  carotid.  The  fifth 
could  only  offer  his  regrets  that  he  had  to  leave 
at  once,  as  he  "  wanted  to  wait  and  see  Lefferts 
stop  this."  These  gentlemen  were  all  educated 
and  skilled  physicians  in  their  own  specialties, 
and  all  but  the  last  seemed  anxious  to  be  of 
service,  but  none  of  them  remembei-ed  the 
simple  surgical  fact  that  direct  pressure  on  the 
mouth  of  any  bleeding  vesssl  will  control  the 
loss  till  other  and  more  permanent  means  of 
checking  it  may  be  adopted.  The  flow  being 
rapid,  I  became  faint  and  exsanguinated  in  a 
short  time,  and  in  the  opinion  of  those  better 
able  than  myself  just  then  to  form  a  correct 
opinion,  I  could  not  have  survived  another 
hour  without  the  help  which  Dr.  McBurney 
afforded.  It  was  tstimated  by  several  gentle- 
men present  that  the  loss  of  blood  amounted  to 
between  six  and  seven  pints.  If  either  my 
friends,  the  throat  s[)ecia,lists,  or  a  good  practi- 
cal ;,ui'geon  Lad  been  present,  when  it  began,  it 
would  not  probably  have  reached  as  many 
ounces,  nor  would  the  general  condition  have 
become  a  dangerous  one. 

Since  that  time  I  have  frequently  had  occasion 
to  perform  tonsillotomy,  and  have  met  with  noth- 
ing more  unsatisfactory  afterwards  than  th  e  loss  of 
an  occasional  fee  for  so  doing.  I  have  knowledge, 
however,  of  nine  cases  besides  my  own  in  which 
a  fatal  rtsult  was  all  but  reached.  One  of 
these  occurred  in  the  practice  of  an  old  fellow- 
student  of  mine  who  now  fills  a  chair  in  a 
western  college.  In  this  case  the  doctor  left  a 
student  to  watch  his  |)atient  and  was  recalled 
in  haste  two  hours  later.  He  found  it  neces- 
sary to  apply  pressure  with  a  sponge  on  a 
holder  for  many  hours,  and  has  stated  that 
without  the  recollection  of  my  experience  and 
treatment  to  guide  him  he  would  have  been  at 
a  loss  to  know  what  to  do. 

From  the  statistics  which  I  have  at  hand, 
based  chiefly  on  the  practices  of  leading  sur- 


OF  MEDICAL  SCIENCE. 


•251 


geons,  I  am  disposed  to  think  that  a  dangerous 
degree  of  hsemorrhage  occurs  in  about  one  per 
cent,  of  all  tonsillotomies.  Tf  with  proper 
after  treatment  it  is  thus  frequent,  may  we  not 
consider  its  risks  to  be  greater  in  connection 
with  that  slap-dash  and  happy-go-lucky  surgery 
with  which  even  in  Ontario  we  are  not  alto- 
gether unacquainted.  We  know  how  often 
some  physicians  meet  with  post-partum  haemorr- 
hage and  are  apt  to  connect  this  frequency  with 
a  fault  or  careless  treatment  of  the  third  stage 
of  labor.  That  obstetrician  will  see  least  of  it, 
probably,  who  has  its  dangers  and  its  preven- 
tion most  constantly  in  his  mind.  The  same 
reasoning  will  apply  to  this  form  of  haemorr- 
hage. With  the  conviction  that  the  liability 
to  haemorrhage  from  the  stump  of  an  amputated 
tonsil  will  be  lessened  by  the  right  performance 
of  the  operation  that  may  cause  it,  I  submit 
without  argument  the  following  conclusions  for 
your  approval  or  amendment : — 

The  surgeon  who  proposes  to  remove  a  tonsil 
should  have  at  hand  a  strong  and  perfectly 
manageable  light,  such  as  is  obtained  from 
a  student's  lamp  and  a  forehead  protector  of 
four  inch  diameter  and  short  focus. 

He  should  not  be  dependent  upon  the  kitchen 
cupboard  for  a  part  of  his  armament,  but 
should  have  a  good  tongue  depressor,  and  tbLs 
is  almost  the  same  as  saying  that  he  should 
have  Turke's  model,  as  for  any,  operation  on 
the  back  of  the  throat  it  is  the  only  good 
one. 

He  should  use  the  tonsillotome  preferably 
for  children,  and  especially  if  ether  be  not 
given.  If  the  part  to  be  removed  be  promi- 
nent he  should  use  this  instrument  for  adults 
also,  and  should  prefer  Mackenzie's  or  Hamil- 
ton's models,  which  cut  by  propulsion,  to  any 
of  the  forms  in  which  a  sickle-shaped  knife 
makes  the  section  as  it  is  being  retracted. 

He  should  use  the  vulsellum  forceps  or 
double-hook  and  probe-pointed  bistoury  for  all 
cases  in  which  the  gland  is  sessile,  or  in  which 
a  particular  portion  of  it  is  to  be  excised.  In 
operating  he  should  stand  before  the  patient, 
seize  the  left  tonsil  and  cut  from  above  down- 
wards, so  as  to  remove  all  that  projects  beyond 
the  anterior  pillar  of  the  fauces.  Then  stand- 
ing behind  the  patient  he  should  remove  to  the 


same  degree  the  right  gland  by  cutting  from 
below  upwards. 

Bearing  in  mind  the  manifold  risks  of  opera- 
ting on  even  small  inflamed  parts,  he  should 
select  a  period  of  quiescence  for  the  amputation, 
the  exceptions  to  this  rule  being  :  first,  that 
class  of  cases  in  which  the  gland  is  very  small 
and  flat  between  the  catarrhal  attacks  upon  its 
secreting  surface  ;  and  second,  the  rare  con- 
dition of  actual  danger  to  life  from  combined 
hypertrophy  and  inflammation. 

The  surgeon  after  a  tonsillotomy  should  not 
lose  sight  of  his  patient  for  several  hours  but 
should  make  frequent  and  careful  inspection  of 
the  throat.  He  should  remember  that,  especially 
in  children,  blood  may  pass  into  the  stomach 
and  give  no  external  sign  till  blanching  of  the 
face  or  faintness  shows  its  loss.  Should  this 
examination  reveal  actual  hsemorrhage  in  un- 
safe amount  he  should  resort  at  once  to  direct 
pressure,  either  with  the  finger  or  a  sponge  on  a 
firm  holder.  After  this  has  been  some  time 
applied  he  should  examine  for  bleeding  jx)ints, 
and  if  found,  they  should  be  caught  and  twisted. 

Cold,  in  the  form  of  ice-water  or  ice  in  sub- 
stance, may  be  made  use  of,  but  it  is  better  to 
avoid  the  application  of  the  styptic  preparations 
of  iron  or  other  asti-ingents.  In  the  rare  event 
of  pressure,  torsion,  and  cold  being,  when  pro- 
perly applied,  insufiicient,  the  ligabing  of  the 
external  carotid  artery,  and  this  also  failing,  of 
the  common  trunk  may  be  taken  into  considera- 
tion. 


CASE  OF  LOCOMOTOR  ATAXIA, 
WHERE  RIGHT  SCIATIC  WAS 
STRETCHED  FOR  RELIEF  OF 
"LIGHTNING    PAINS." 

BY   J.    STEWART,    M.D.,    BRUCEFIELD. 
Read  before  the  Ontario  Medical  Association,  May,  1882. 

M.  Shea,  aged  43,  when  first  seen  in  Sept. 
of  1881,  complained  of  shooting  pains  in  his 
legs,  thighs,  and  lower  part  of  the  abdomen. 
He  also  complained  of  an  inability  to  walk  in 
the  dark,  and  giddiness.  The  pains  made  their 
first  appearance  twelve  years  ago,  while  he  was 
engaged  in  working  in  the  lumber  woods  of 
Wisconsin.  His  occupation  was  that  of  a 
driver,  and  he  was  compelled  to  sit  for  houra  on 


252 


CANADIAN  JOURNAL 


the  cold  logs,  and  it  is  to  cold,  contracted  in  this 
way,  that  he  attributes  his  present  trouble.  For 
several  years  the  pains  only  recurred  at  long 
intervals ;  but  lately  he  is  seldom — rarely  more 
than  24  hours — free  from  them.  They  have 
also  greatly  increased  in  severity  during  the 
last  two  years,  and  especially  during  the  last 
few  months.  He  first  noticed  that  he  was  apt 
to  stumble  in  the  dark,  five  years  ago.  The 
ataxia  has  steadily  increased  during  this 
period.  For  several  months  it  has  been  so 
pronounced  that  he  has  been  unable  to  perform 
his  usual  work.  With  the  exception  of  gon- 
orrhoea, he  never  had  any  illness.  He  is 
certain  that  he  never  had  syphilis. 

Family  history  is  good.  He  says  he  never 
ate  or  drank  to  excess. 

State  on  t/ie  Ist  of  Oct.,  1S81,  being  two  weeks 
2)rior  to  tlte  stretching  of  t/ie  rigid  sciatic  nerve. 

The  lightning-like  pains  with  which  he  is 
afflicted  recur  very  frequently  ;  the  longest 
interval  of  freedom  from  them  during  the  last 
year  has  been  only  five  days.  They  generally 
affect  the  lower  extremities.  It  is  but  seldom 
that  he  complains  of  pain  elsewhere,  and  then 
only  in  the  left  arm.  The  pains  are  of  extreme 
severity,  but  only  of  momentary  duration. 
They  generally  last  24  hours,  and  during  tliat 
time  a.e  nearly  always  confined  to  a  small  spot. 
A  favourite  situation  for  them  is  the  dorsum  of 
the  right  foot.  When  they  1  ist  for  twenty -four 
hours  it  is  always  noticed  that  the  limb  which 
has  been  their  seat  has  atrophied.  Repeated 
measurements  have  shown  a  diminution  of  half 
an  inch  in  the  circumference  of  the  limb.  He  is 
very  slow  to  appreciate  painful  sensations  when 
applied  to  the  two  lower  and  left  upper  extrem- 
ities. In  the  feet  there  is  an  interval  of  about 
six  seconds  before  he  is  able  to  feel  a  severe 
pinch  or  the  prod  of  a  needle.  In  the  legs  this 
interval  is  five,  and  in  the  thigh  eight  seconds. 
He  feels  the  simple  rubbing  of  the  hairs  on  his 
legs  much  more  readily  than  a  severe  pinch  of 
the  skin.  He  is  able  to  distinguish,  although 
slowly,  the  difference  between  a  hot  and  a  cold 
application,  when  applied  to  his  lower  extrem- 
ities. With  his  eyes  shut  he  is  unable  to 
touch  the  point  of  his  nose  with  either  hand, 
nor  is  he  able  to  point  out  the  position  of  his 
feet       His   sight   is   good,    although   there  is 


commencing  atrophy  of  both  discs.  The  pupils 
react  slowly  to  light,  but  readily  when  the  eyes 
are  accommodating.  There  is  no  myosis  or 
paralysis  of  any  ocular  muscle.  He  is  able  to 
distinguish  colours.  His  hearing,  taste,  and 
smell  are  all  normal. 

He  complains  greatly  of  numbness  of  both 
lower  extremities,  and  of  a  very  disagreeable 
sensation,  as  if  the  skin  were  too  tight  for  his 
legs.  When  walking  he  has  to  keep  his  eyes 
on  his  feet  or  he  would  fall,  and  he  feels  as  if 
he  were  treading  on  some  soft  substance. 
There  is  loss  of  sensation  in  the  thumb,  index, 
and  middle  finger  of  the  left  hand.  He  is  able 
to  retain  his  urine  without  causing  him  the 
least  inconvenience  for  over  twenty-four  hours. 
To  empty  his  bladder  he  has  to  strain  very 
much.  He  is  troubled  with  obstinate  consti- 
pation. He  says  he  often  feels  as  if  a  weight 
of  one  hundred  pounds  was  compressing  his 
waist.  When  standing  or  walking  he  complains 
of  what  he  calls  a  cramp-like  condition  of  the 
muscles  of  the  lower  part  of  the  abdomen. 
The  patellar  tendon  reflex  is  absent  on  each 
side.  There  is  no  ankle  clonus  or  plantar 
reflex.  The  cremasteric  and  epigastric  reflexes 
are  absent.  When  walking,  his  knees  often 
give  away  suddenly  imder  him.  He  says  that 
for  this  reason  he  avoids  as  much  as  possible 
walking  on  the  streets.  He  has  the  character- 
istic gait  of  an  ataxic.  He  is  unable  to  walk 
or  stand  with  his  eyes  shut.  Intelligence  and 
memory  are  not  affected.  Lately  he  has  been 
at  times  melancholy,  at  other  times  he  is  in  the 
best  of  spirits. 

On  the  14th  of  October  the  right  sciatic  was 
stretched.  The  right  was  chosen  on  account  of 
the  pain  being  generally  more  severe  in  that 
limb.  The  night  following  the  operation  the 
pains  set  in  on  the  outer  side  of  the  right  knee, 
and  were  severer  than  they  ever  had  been. 
The  following  day  they  left,  and  did  not 
reappear  for  three  weeks.  This  was  the  lungest 
interval  of  freedom  from  the  pains  since  they 
first  commenced,  twelve  years  previously.  It 
is  now  about  eight  months  since  the  operation 
was  performed,  a  period  suflicieutly  long  to 
judge  what,  if  any,  influence  the  stretching  has 
exercised  on  the  disease  or  its  symptoms.  The 
results  may  be  summed  up  as  follows  : — 


OF  MEDICAL  SCIENCE. 


•253 


(1.)  On  the  pain.  The  result  on  the  whole 
has  been  very  satisfactory.  Previously  he 
suffered  nearly  one-fourth  of  the  whole  time 
from  the  pains,  which  were  of  an  agonizing 
character.  Now  he  seldom  has  attacks  oftener 
than  once  every  three  weeks,  and  he  has  been 
as  long  as  six  ^eeks  free.  Before  the  operation 
the  pains  set  in  suddenly,  with  great  severity, 
and  left  just  as  suddenly.  Since  its  perform- 
ance they  come  on  by  degrees,  increase  up  to  a 
certain  pitch,  then  decline  slowly.  During 
the  wave  of  ascent  the  intervals  become  shortei- 
and  shorter,  and  during  the  wave  of  descent 
they  become  longer  and  longer,  until  finally 
they  cease  altogether. 

(2.)  On  tlie  patellar  reflex.  Previous  to  the 
stretching  there  was  absolutely  no  response, 
but  since  there  has  been  an  appreciable  jerk 
when  the  tendon  is  struck.  It  is,  however, 
very  late  in  making  its  appearance,  there  is 
often  an  interval  of  two  seconds  between  the 
tap  and  the  I'esponse.  According  to  Eulen- 
burg  *  the  interval  should  only  be  the  -^^  of  a 
second.  This  he  found  to  be  the  interval  in 
the  examiantion  of  80  healthy  male  adults. 

(3.)  On  the  delayed  sensation.  Prior  to  the 
operation  it  took  him  from  five  to  eight  seconds 
to  feel  the  stab  of  a  needle  in  either  lower 
extremity.  He  can  readily  appreciate  now, 
and  has  since  the  stretching,  a  similar  irrita- 
tion in  from  one  to  two  seconds. 

(4.)  On  the  muscular  sense.  Up  to  the  time 
of  operating,  it  was  with  the  greatest  difficulty, 
and  then  only  after  repeated  trials  that  he 
could  touch  his  nose  or  point  to  the  position  of 
his  toes  when  his  eyes  were  shut.  He  can 
readily  perform  these  acts  now. 

(5.)  On  the  ataxia,  etc.  The  oi:)eration  did 
not  exercise  the  least  beneficial  influence  over 
the  ataxic  symptoms.  Neither  was  there  any 
favourable  change  made  over  either  the  bladder 
or  rectum  symptoms.  The  ataxia  has  been 
steadily  progressive.  The  sense  of  weight 
around  the  lower  part  of  the  abdomen  is  as 
great  as  ever. 

A    very   interesting    symptom    occurred   six 

*  Ueber  die  Latenzdauer  und  den  pseudoreflectoris- 
chen  charakter  der  schnenphanomene.  Nemg.  Centl. 
No.  1. 


days  after  the  stretching,  viz.  :  a  very  exten- 
sive haemorrhage  from  the  wound  and  into  the 
subcutaneous  tissue  of  the  limb  operated  on. 
The  bleeding  was  copious  enough  to  saturate 
all  the  antiseptic  dressings,  and  even  find  its 
way  through  the  bed. 

This  was  likely  the  result  of  the  pains  which 
set  in  a  few  hours  after  the  operation,  and 
lasted  with  great  severity  for  nearly  twenty- 
four  hours.  This  is  a  more  probable  explana- 
tion than  that  the  result  was  from  any  injury 
sustained  by  the  vessels  from  the  stretching. 
Straus  *  reports  several  cases  of  extensive 
subcutaneous  haemorrhages  following  the  pains 
of  ataxia. 

These  ecchymoses  are  probably  induced  by 
direct  irritation  of  the  vaso-dilator  fibres.  It 
has  been  shown,  both  by  Brown-Sequard,  and 
Strieker,  that  the  posterior  roots  contain  vaso- 
dilating fibres.  If  this  view  is  correct,  then 
the  ecchymoses  and  the  lightning  pains  are 
caused  by  the  same  morbid  process. 

SOME  POINTS  OF  GENERAL  INTEREST 
IN  OPHTHALMOLOGY. 

(Paper  read  at  Meeting  of  Toronto  Medical  Society, 
May  18th,  1882.) 

BY    R.    A.    BEEVE,    B.A.,    M.D., 

Lecturer  on  Diseases  of  the  Eye  and  Ear  in  Toi'onto 

School  of  Medicine  ;  Oculist  and  Aurist  to 

Toronto  General  Hospital. 

(Concluded  from  page  221.) 

CATARACT. 

Idiopathic  cataract  is  characterized  by  a 
gradual,  painless  failure  of  sight,  the  lens  be- 
coming opaque  in  a  seemingly  healthy  eye. 
Some  degree  of  irritability  may  be  felt  but 
the  external  signs  of  inflammation  are  wanting  ; 
and  the  pupil  retains  its  normal  size  and  activity, 
presenting,  however,  as  the  process  advances,  a 
more  and  more  marked  gray  or  milky  back- 
ground. There  is  a  physiological  haziness  of 
the  lens  in  old  subjects,  and  also  a  gray  pupil- 
lary reflex  in  some  diseases  of  the  fundus  oculi 
and  vitreous.  A  hasty  diagnosis  should,  there- 
fore, not  be  made,  but  a  routine  method  follow- 
ed, even  in  most  of  the  cases  which  seem 
beyond  doubt.     The  history  should  of  course 

*  Archives  dc  Axurologie,  No.  4,  1881. 


254 


CANADIAN  JOURNAL 


be  got,  and  the  state  of  the  eye  ns  to  tension,* 
sight,  and  visual  fieldt  learned  ;  oblique  illum- 
ination J  should  be  practised  ;  and  the  ojihthal 
mosoope  should  be  used,  because  one  can  souie- 
tiines  get  a  view  of  the  fundus  through  a  lens 
which  seems  opaque,  and  upon  the  mirror  we 
may  have  to  depend  in  deciding  that  the 
dimness  of  vision  is  due,  not  to  lenticular 
opacity,  but  to  morbid  changes  in  the  vitreous, 
retina  etc.,  which  would  invalidate  an  operation. 
In  a  small  percentage  of  subjects  beyond  the 
prime  there  is  a  preliminary  swelling  of  the 
lens,  so  that  the  eye  becomes  myopic  and  read- 
ing glasses  can  be  dispensed  with, — tlie  so- 
called  '  second  sight,'  which,  however,  in  due 
course,  gives  place  to  the  fogginess  and  gloom  of 
confirmed  cataract.  Some  seem  to  think  a 
cataractous  eye  should  be  quite  blind,  but  even 
when  simple  cataract  is  mature,  one  can  discern 
the  position  of  windows  and  of  artificial  lights, 
and  the  motion  ot  fingers  or  other  objects  be- 
tween the  eye  and  the  light,  as  the  natural  eye 
can  through  frosted  glass.  Inability  to  do  this 
generally  contra-indicates  an  operation.  I 
have  known  a  lens  to  be  removed  from  a  sight- 
less ball  and  then  the  dread  alternative  pre- 
sented of  enucleation  or  possible  loss  of  the 
second  eye  from  sympathetic  inflammation;  and, 
again,  a  cataract  to  be  extracted  from  a  hope- 
lessly diseased  organ,  and  at  the  same  sitting 
the  clear  lens  of  the  fellow  eye  also  taken  out, 
the  gray  pupillary  reflex  in  the  latter  case  being 
really  due  to  deep-seated  changes. 

Cataract  often  develops  without  apparent 
cause,  and  this  is  a  common  experience.  It 
may  be  secondai-y  to  glaucoma,  disease  of 
choroid,  diabetes,  etc.,  or  due  to  a  jostling  of 
the  lens  in  its  fossa  or  its  luxation  from  concus- 

•  *  The  tension  is  tested  by  gentle  palpation  with  the 
tips  of  the  index  fingers  placed  upon  the  upper  lid,  the 
eye  being  closed  and  the  patient  looking  downwards. 
The  globe  should  dimple  under  very  slight  pressure. 

t  A  lighted  match  or  taper  is  moved  to  and  fro,  up 
and  down  etc.,  the  eye  looking  straight  forward,  and 
should  be  seen  over  the  normal  field  or  area,  lilank 
portions  or  marked  contractions  point  to  deep-seated 
disease. 

X  Light,  generally  artificial,  is  thrown  obliquely  into 
the  pupil  by  means  of  a  strong  convex  lens.  The 
peripheral  striae,  small  opacities  or  central  haziness  of 
incipient  cataract  are  thus  revealed,  and  more  marked 
lens  changes  well  displayed. 


sion  of  the  eyeball.  There  is  often  an  heredi- 
tary tendency  to  cataract,  and  in  many  cases  it 
seems  fairly  attributable  to  excessive  use  of  the 
eyes.  The  lens  substance  also  becomes  opaque 
when  the  aqueous  humor  has  direct  access  to  it 
through  a  puncture  or  rent  of  the  capsule,  as 
by  a  foreign  body,  instrument,  or  blow  ;  and, 
again,  where  the  iris  is  largely  adherent  to  the 
lens  capsule,  owing  to  neglected  iritis,  second- 
ary opacity  of  the  lens  is  apt  to  supervene. 

Idiopathic  cataract  is  generally  double,  and 
formerly  it  was  the  practice  not  to  operate  for 
hard  cataract  until  the  second  eye  became 
blind.  It  is  now  held  that  the  prolonged 
anxiety  and  enforced  physical  inactivity  caused 
by  such  delay  militate  against  the  success  of  the 
operation,  and,  therefore,  extraction  of  the 
cataract  first  mature  is  often  done  while  the 
other  is  yet  immature.* 

Advanced  age  is  no  bar  to  the  operation  if 
there  be  a  fair  degree  of  vitality.  Those  who 
are  inordinately  fat  or  are  prone  to  marasmus, 
and  the  victims  of  dyspepsia  or  alcoholism  are 
not  good  subjects  for  extraction.  The  old 
"  flap  "  operation,  done  with  a  broad  triangular 
knife,  is  very  largely  supplanted  by  some 
modification  of  the  "  modified  linear  "  or  "  peri- 
pheral linear "  method,  the  characteristics  of 
which  are,  the  use  of  a  narrow  or  linear  knife, 
a  curvilinear  section  across  the  summit  (or  bot- 
tom) of  the  cornea,  and  excision  of  a  segment  of 
iris.  It  has  also  the  advantage  of  entailing  a 
much  shorter  confinement  to  bed,  thirty -six 
or  forty-eight  hours  generally  sufficing ;  and 
of  a  wider  range  of  applicability,  in  regard  to 
the  maturity  of  the  cataract  and  the  age  and 
degree  of  vitality  of  the  patient.  In  the  treat- 
ment of  soft  cataract,  namely  that  ensuing  up  to 
the  age  of  thirty  or  thirty-five,  by  the  ordinary 
method  of  needling,  discission,  or  solution, 
advantage  is  taken  of  the  fact  that  the  aqueous 
humour  will    attack  and  dissolve  the  lens  sub- 

*  Peripheral  capsulotomy,  the  opening  of  the  capsule 
near  the  margin  of  the  kus,  contiguous  to  the  corneal 
section,  enables  us  to  operate  with  comparative  impunity 
on  immature  cataracts,  a  practice  which  1  have  followed 
with  advantage  in  some  instances.  The  rule  still  holds, 
however,  that  it  is  better  to  wait  until  the  cataract  is 
rife,  i.e.,  until  the  lens  is  opaque  up  to  the  plane  of  the 
iris,  and  the  patient  unable,  or  barely  able,  to  count 
fingers. 


OF   MEDICAL  SCIENCE. 


255 


stance  when  allowed  direct  access  to  it.  Tlie 
needle  is  entered  through  the  cornea,  not,  as 
formerly,  through  the  sclerotic  ;  hence  the 
term  keratonyxis.  Instead  of  resorting  to 
repeated  needling  during  the  thi-ee  or  six 
months  required  to  effect  absorption  of  the 
lens,  linear  extraction  is  sometinies  adopted  as 
an  expeditious  and  comparatively  safe  substi- 
tute, the  lens  substance,  rendered  fiocculent 
and  diffluent  by  maceration  for  a  few  days  in 
the  aqueous  after  a  free  needling,  being  gently 
extruded  through  a  short  corneal  incision. 
Suction  by  means  of  careful  aspiration  through 
a  tube  or  by  the  use  of  a  syringe  is  sometimes 
practised,  instead  of  evacuation  by  pressure  and 
use  of  the  curette.  But  it  is  better  to  make 
haste  slowly  in  many  of  these  cases,  simple 
needling  being  the  safest  procedure.'  As  already 
explained,  lesion  of  the  capsule  or  disturbance 
of  nutrition  by  violence  is  followed  by  more  or 
less  diffuse  opacity  of  the  lens,  and,  therefore, 
traumatic  cataract  is  a  not  uncommon  condition. 
In  such  cases  it  is  important  to  secure  the 
maximum  dilatation  of  the  pupil  at  the  eax-liest 
mament  and  keep  it  up  by  the  use  of  a  strong 
mydriatic,  as  sol,  ati'opia?  sulpb,  gr  4-8  ad  §  aq. 
Cold  or  ice  water  dressings  may  be  required, 
and  they  often  do  good  service,  during  the  first 
few  days.  In  traumatic  cataract  an  operation 
may  be  unnecessary,  absorption  of  the  lens 
quietly  taking  place,  but  in  older  subjects 
extraction  may  be  required,  and  in  younger 
linear  extraction  may  be  done.  The  latter  or 
a  j)aracentesis  is  imperative  if  the  eye  becomes 
hard  (glaucomatous)  or  very  irritable  owing  to 
rapid  swelling  of  the  lens,  etc.  Not  unfrequently 
the  posterior  capsule  becomes  gauze-like  or 
partly  opaque  after  extraction,  and  more  decid- 
edly so  after  iritis, — so-called  secondary 
cataract.  Supplementary  needling  is  then 
required,  or  a  resort  to  iridotoray, — the  divi- 
sion of  pupillary  membranes  and  iris  by  means 
of  a  delicate  pair  of  scissors  entered  through 
an  incision  in  the  cornea.  Very  strong  convex 
lenses  have  to  be  worn  after  extraction,  and 
with  these  the  final  visual  result  is  pretty  satis- 
factory in  about  85  per  cent,  of  the  cases  ; 
ability  to  read  ordinary  print  being  recovered 
in  about  75  per  cent.;  and  sight  enough  to  go 
about  alone  in  90  per  Cc;nt. 


GLAUCOMA. 

The  chief  characteristic  of  this  interesting 
morbid  condition  is  increased  tension  or  plump- 
ness of  the  eyeball,  which,  when  in  any  marked 
degree,  can  be  readily  recognized  by  palpation. 
It  is  to  be  feared  many  eyes  are  allowed  to  be- 
come hopelessly  spoiled  for  lack  of  this  simple 
procedure,  which  is  too  little  practised.  Pri- 
mary glaucoma  may  be  of  inflammatory  or  non- 
inflammatory form,  and  the  glaucomatous  state 
is  also  secondary  to  other  diseases,  as  kei*atitis, 
staphyloraft,  dislocated  lens,  tumour,  hajmor- 
rhagic  retinitis,  «tec.  Idiopathically,  it  generally 
occurs  in  subjects  over  forty-five  years,  and 
mostly  in  females.  Dyspepsia  seems  to  pre- 
dispose to  it,  and  an  inflammatory  attack  is 
sometimes  lighted  up  by  great  fatigue,  anxiety, 
or  shock.  Occasionally,  it  occurs  in  3'oun" 
subjects  by  virtue  of  heredity,  and,  now  and 
ihen,  the  instillation  of  atropine  acts  as  an 
exciting  cause  in  older  persons,* 

Simple,  chronic,  or  non-inJlam,matory  glau- 
coma is  insidious  in  its  progress,  and  the  globe 
may  have  become  tense,  the  visual  field  con- 
tracted to  a  very  small  area,  only  central  vision 
and  that  defective  being  retained,  and  the 
optic  disc  atrophied  and  sunken  from  pressure, 
the  eye  meanwhile  looking  healthy  and  the 
subject  only  aroused  to  the  active  condition  by 
the  second  eye  following  suit, — a  calamity  that 
generally  occurs  :  vision  fails  more  and  more, 
sometimes  with,  often  without,  intercurrent 
inflammation,  the  pupil  is  fixed  and  genei^Uy 
dilated,  the  lens  possibly  cataractous,  the  globe 
becomes  distinctly  hard,  and,  finally,  the  sight 
extinct,     (G,  absolutum,) 

In  the  acute,  inflammatory  form  the  symp- 
toms are  indicative  of  actual  mischief — in- 
tense pain,  oedema  of  lids,  turgescence  an.._ 
hardness  of  the  globe,  steamy  cornea,  dilated 
fixed  pupil,  and  blindness.  Often  there  is 
sympathetic  vomiting,  and  sometimes  the  diag- 
nosis of  a  "  bilious  attack "  has  been  made, 
spontaneous  j)artial  recovery  may  occur,  but 
relapses  ensue   and   the   eye  is  lost,  and  ulti- 

*  For  a  number  of  years  it  has  been  the  writer's 
practice  not  to  use  atropine  for  ophthalmoscopic  cases. 
At  any  rate,  strong  solutions  are  unnecessary  and  need- 
lessly unpleasant,  a  very  weak  solution,  gr.  |,  J  ad. 
^.i.  aq.  geuemlly  sutficing. 


256 


CANADIAN  JOURNAL 


mately  tho  other  one  too,  unless  there  be  timely 
interference.  There  is  generally  a  "  premoni- 
tory "  stage  of  several  months  duration,  a 
prominent  subjective  symptom  being  the  ob- 
servance of  coloured  rings  as  of  rainbow  hues 
when  looking  at  an  artiHcial  light,  associated 
with  transient  fogginess. 

The  etiology  of  glaucoma  is  engaging  much 
attention,  and  tho  following  are  the  main 
factors  and  features  of  this  morbid  process  : 
Increased  tension  is,  with  hardly  an  exception, 
considered  the  essential  fact  of  th«  disease, 
though  in  the  G.  simplex  optic  nerve  atrophy 
plays  an  important  role  and  the  treatment 
directed  to  tension  is  sometimes  only  of  partial 
bene6t  or  useless  ;  undue  rigidity  of  the  sclera  ; 
serous  choroiditis  and  intraocular  hypersecre- 
tion of  possible  neurotic  origin ;  defective  ex- 
cretion or  escape  of  fluids  by  virtue  of  narrow- 
ing of  the  space  between  the  lens  margin  and 
the  ciliary  processes  by  swelling  of  one  or 
other,  and  also  contact  or  union  of  the  peri- 
pheral part  of  the  iris  and  sclero-corneal  junc- 
tion, impeding  or  closing  the  avenues  to  the 
important  venous  canal  there  ;  atrophy  of  the 
ciliary  muscle,  etc.  A  pathological  condition  of 
some  interest  is  the  recession  of  the  face  of 
the  optic  nerve  towards  the  lamina  cribrosa 
as  the  result  of  pressure,  producing  what  is 
termed  pressure-excavation  or  cupping,  a  charac- 
teristic feature  ot  confirmed  glaucoma  readily 
recognizable  with  the  ophthalmoscope.  The 
field  of  vision  is  also  affected  after  a  manner 
sufficiently  common  to  be  considered  charac- 
teristic, inability  to  see  objects  on  the  nasal 
side  being  first  noticed,  and  then  above  and 
below,  and  so  on  until  only  a  central  sensitive 
point  or  islet  remains.* 

Iridectomy  was  for  years  the  only  radical 
treatment  of  glaucoma, — "  curing  "  as  if  by 
magic  the  inflammatory  form  and  arresting  most 
of  the  simple  chronic  cases.  Its  record  is  a 
brilliant  one  :  it  has  saved  myriads  of  eyes  and 
averted  an  incalculable  amount  of  sufferings 
To  be  most  effective  it  should  he  done  promptly 
in    the    inflammatory  variety,  and   before   the 

*  In  testing,  one  eye  should  be  closed  and  the  other 
directed  straight  forward.  One's  hand  or  a  white  watch 
dial  makes  a  good  test  object.  If  cataract  be  present  an 
artificial  light  is  needed. 


field  of  vision  is  very  much  curtailed  in  the 
non-inflam  m  a  tory . 

Sclerotomy,    in    which    a   carefully-executed 
incision   by   means  of  a  narrow  knife,  is  made 
in  the  sclero-corneal  junction  without  removal 
of  any  iris,  is  now  being  practised  in  lieu  of 
iridectomy    proper   for    tho    relief  of   tension, 
notably  in  the  later  stages  of  non-inflammatory 
glaucoma ;  on  the  supposition  that  the  escape 
of  intra-ocular   fluids   by    means  of  filtration 
through  the  cicatrix  contiguous  to  the  impor- 
tant venous  and  lymph  channels  of  that  region, 
is  the  real  remedial  process,  and  excision  of  iris 
largely  su))erfluou3.     The  place  to  be  filled  by  it 
is  not   fully  determined.     Eserin  is    of  great 
value  in  inflammatory  glaucoma,  repeated  in- 
stillations (of  eseiin  sulph.  gi-s.  iv. — viij.  ad.  5J, 
aq.)  at  short  intervals  causing  generally  marked 
reduction  of  tension  and  abatement  of  symp- 
toms.    In  some  instances   acute   attacks   and 
also  milder  sub-acute  seizures  are  tided  over  by 
its  use  alone,  and  in  others  the  eye  is  saved 
from  iiTetrievable  damage  until  an  iridectomy 
can   be  done.     It  is  sometimes  of  service  in 
chronic  glaucoma,  though  occasionally   injuri 
ous.      Its  value  in  arresting  staphyloma  and 
aveiting  secondary  glaucoma,  &c.,  in  extensive 
ulceration  of  cornea  has  been  already  noticed. 
Simple  chronic  glaucoma  is  sometimes  con- 
founded with  cataract  because  the  lens  seems 
hazy  and  the  sight  is  somewhat  impaired,  the 
eye  appearing  healthy,  and  also  because  when 
it  is  fully  confirmed  the  lens  is  often  cataract- 
ous.     But,  as  already  noted,  in  idiopathic  cata- 
ract the  eye  is  of  normal   tension,  the  pupil 
active,  and  the  visual  field  unaffected.     Cata- 
ract with  dilated  pupil  generally  means  glaxi- 
coma,  and  if  the  eye  be  not  hard  it  is  likely 
quite  blind  from  some  other  disease.     In  very 
young  subjects  we  sometimes  find  the  pupil  di- 
lated and  the  eye  more  or  less  hard,  and  a  creamy 
reflex  from  the  depths  of  the  eye,  but  the  2)rimal 
mischief  is  glioma  of  the  retina,  which  is  itself 
sometimes  mistaken  for   cataract    though    the 
lens  is  generally  clear.     Inflammatory  glaucoma 
is  distinguished  from  iritis  by  the  hardness  of  the 
globe,  suddenness  of  onset,  and  of  loss  of  sight, 
and  dilatation  of  the  pupil.    In  iritis,  excepting 
the  rare   serous  form,   the   eye    is    of   normal 
tension  and  the  pupil  contracted. 


OF  MEDICAL  SCIENCK. 


257 


INJURIES, 

The  eye  has  wonderful  reparative  powers, 
and  will  bear  a  deal  of  damage  of  a  certain 
kind.  There  is  one  part  of  it,  however,  which 
is  very  intolerant  of  injuiy,  namely,  the  ciliary 
region,  corresponding  to  a  circum-corneal  zone 
of  about  5  mm.  in  width  ;  and  a  small,  pene- 
trating wound  there  may  set  up  serious  inflam- 
mation (cyclitis,  irido-choroiditis,  etc.),  with 
loss  of  the  eye,  and,  finally,  of  its  fellow. 
Cases  where  the  ciliary  body  is  involved,  which 
fully  recover,  may  be  considered  exceptional 
The  entangling  of  the  iris  in  corneal  wounds  or 
incisions,  causing  much  traction  upon  its  tissue 
or  irritation  of  the  ciliary  nerves,  is  a  source  of 
danger  not  to  be  despised.  Happily,  we  are 
now  armed  with  a  valuable  remedy,  eserine,  the 
instillation  of  which  done  early  in  strong  solu- 
tions (grs.  2 — 4  ad.  §j.  aq.),  by  virtue  of  its 
powerful  myotic  properties  draws  the  iris  out 
of  the  lips  of  peripheral  wounds,  or  materially 
lessens  its  involvement.  *  In  cases  of  prolapse 
of  the  iris,  if  seen  at  once,  the  "  hernia  "  can 
sometimes  be  reduced  by  means  of  a  slender, 
blunt  probe,  carefully  handled,  and  if  this 
attempt  or  the  vigorous  use  of  eserine  does  not 
avail,  it  is  advisable  in  many  cases  to  excise 
the  knuckle  in  the  wound,  or  if  a  cystoid 
cicatrix  should  have  formed,  to  split  it  open 
and  attempt  removal  of  the  part  involved,  or 
do  an  iridectomy.  In  more  or  less  central 
corneal  wounds,  especially  with  injury  to  the 
lens,  atropine,  not  eserine,  is  indicated.  Trau- 
matic cataract  has  been  already  referred  to, 
but  it  should  be  noted  that  in  cases  of  violence 
to  the  eyeball  without  apparent  damage,  the 
prognosis  should  be  somewhat  guarded  in  view 
of  the  possible  development  of  cataract,  or  of 
detachment  of  the  retina,  which  is  a  not  in 
frequent  result.  Rupture  of  the  choroid  may 
also  occur.  (I  have  seen  one  instance  of  the 
almost  unique  rupture  of  the  retina  without  ex- 
ternal lesion).  Not  infrequently  a  good  recovery 
follows  a  moderate  extravasation  of  blood  from 
traumatism,  either  spontaneously  or  under 
treatment  by  rest,  ice-water  dressings,  atropine, 
local  depletion  etc,  ]  but  a  copious  intra-ocular 
haemorrhage  puts  the  eye  in  a  critical  state 
because  inflammatory  and  other  changes  are 
likely  to  supervene.     A   foreign  body  on  the 


iris  should  be  removed  without  delay  through 
a  corneal  incision,  excision  of  the  underlying 
iris  tissue  being  often  necessary,  but  if  it  be  a 
metallic  particle  and  capable  of  responding, 
the  use  of  a  magnet  would  likely  suffice, — a 
lai'ge  one  being  held  close  to  the  corneal  wound 
or  cut,  or  else  a  probe-point  attachment  passed 
within  the  anterior  chamber.  This  expedient 
might  also  effect  removal  from  the  region  of  the 
lens  as  well  as  the  anterior  part  of  the  vitreous. 
A  foreign  body  in  the  vitreous  chamber  can 
not  unfrequently  be  seen  with  the  ophthalmo- 
scope or  its  pathway  traced  ;  and  even  when 
the  vitreous  has  become  hazy  and  the  lens 
more  or  less  opaque,  the  presence  and  position 
of  the  intruder  may  sometimes  be  determined 
by  testing  the  field  of  vision  with  a  lighted 
taper ;  a  blank  or  blind  spot  gives  a  fairly 
reliable  indication.  And  again,  the  holding  of 
a  large  magnet  close  to  an  eye  containing  a 
metallic  substance  capable  of  responding,  will 
cause  pain  (by  motion)  in  the  globe  if  encapsu- 
lation by  lymph  etc.,  have  not  occurred.  The 
lighting  up  of  severe  inflammation  after  a 
quiescent  period  or  interval  of  some  days  fol- 
lowing recovery  from  the  immediate  eff'ects  o 
injury,  points  strongly  to  the  presence  of  a 
foreign  body  ;  and  if  a  fair  trial  of  the  usual 
antiphlogistic  treatment  by  rest,  atropine, 
cold  water  dressings,  local  depletion  etc.,  should 
fail,  and  the  case  g«>  on  from  bad  to  worse,  the 
enucleation  of  the  eye  is  pretty  clearly  indicated. 
Some  lesions  condemn  an  eye  at  once  to  extirpa 
tion,  e.g.,  extensive  rupture  involving  the  ciliary 
region  even  without  the  presence  of  a  foreign 
body,  and,  sooner  or  later,  this  is  generally  its 
fate;  also  when  a  foreign  body,  even  a  tiny  one, 
is  lodged  in  the  vitreous  chamber;  for  successful 
removal  or  tolerance  with  preservation  of  a 
useful  organ  is  the  exception.  The  use  of 
magnets  for  the  extraction  of  metallic  sub- 
stances will  increase  the  number  of  recoveries. 

SYMPATHETIC    OPHTHALMIA. 

The  subject  of  injuries  naturally  leads  to 
that  of  sympathetic  o])hthalmia,  though  it 
should  not  be  forgotten  that  the  latter  is  not 
always  due  to  traumatism.  Although  its 
exact  etiology  is  not  fully  known,  sympathetic 
ophthalmia  is  a  dread  reality,  and  its  chapter  is 
a   painfully   interesting   one.     There  are   two 


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CANADIAN  JOURNAL 


broad  classes  of  lesion  which  may  entail 
mischief  in  the  fellow  eye,  namely,  A.  wounds, 
es})ecially  those  involving  the  ciliary  region  or 
**  dangerous  zone  ; "  and  the  presence  of  foreign 
bodies ;  B.  Inflammatory,  degenerative  and 
other  changes,  which  may  or  may  not  be  due  to 
original  injury.  Even  a  neglected  iritis  with 
closed  pupil  and  consecutive  changes  may 
excite  it.  It  may  develop  as  early  as  two 
weeks,  (or  even  less)  after  the  primary  lesion, 
but  even  in  young  subjects,  who  are  the  most 
susceptible,  not  generally  sooner  than  four  to 
six  weeks;  and  months  or  years  frequently 
elapse,  the  offending  member  being  possibly 
partly  atrophied  and  in  a  state  of  chronic  or 
recurrent  inflammation  (irido-choroiditis),  with 
tenderness  in  some  part  of  the  ciliary  region  re- 
senting pressure  and  enforcing  care  in  washing 
the  face,  «fec.  The  sympathetic  trouble  may  be 
confined  to  a  group  of  symptoms  termed  sympa- 
thetic irritation,  with  more  or  less  photophobia, 
lachrymation,  asthenopia  or  "  weakness,"  and 
transient  fogginess.  This  condition  raay  persist 
for  a  good  while  without  organic  changes,  but 
its  occurrence  should  prove  a  warning  to  both 
patient  and  practitioner.  S.  inflammation  is 
generally  a  plastic  iritis  or  irido-choroiditis,  in- 
sidious, and  often  painless  in  its  onset,  protracted 
and  prone  to  relapses,  almost  intractable,  and  as 
a  rule  ending  in  closed  pupil,  with  degenerated 
iris  glued  to  lens  capsule,  hazy  or  cataractous 
lens,  with  also  vitreous  and  retino-choroidal 
changes;  truly,  a  rather  hopeless  state  of  things. 
It  is  superfluous  to  say  that  the  great  point  is 
prevention,  by  a  timely  enucleation.  Once 
established,  the  removal  of  the  primarily  affected 
eye,  though  that  may  be  indicated,  will  not 
arrest  it  or  undo  the  mischief.  It  is  easier 
to  remove  an  eye  than  sometimes  to  take  the 
responsibility  of  sacrificing  it,  but  the  opinion 
of  some,  that  when  sympathetic  inflammation 
has  been  actually  set  up  it  is  useless,  nay,  may 
be  positively  injurious  to  extirpate,  should  not  be 
unduly  magnified,  nor  should  it  afibrd  any  ground 
for  neglecting  to  advise  enucleation  as  a  pro- 
phylactic measure.  Some  authorities  decline  to 
extirpate  an  eye  which  is  suppurating,  fearing 
secondary  meningitis,  dec,  but  in  my  own  ex- 
perience, covering  a  number  of  cases,  there  has 
been  no   mishap,  the   only  special   precaution 


being  the  free  application  of  saturated  solution 
of  boracic  acid  by  means  of  the  sponges  or  ab- 
sorbert  cotton  to  the  eye  and  parts  during  the 
operation  and  as  a  dressing  (iced),  with  berated 
vaseline,  for  a  few  days  afterwards. 

LACHRYMAL    AFFECTIONS. 

By  the  very  nature  of  the  case  derangement 
of  the  lachrymal  apparatus  may  cause  untold 
annoyance  ;  and  as  epiphora  is  very  common, 
it  is  well  that  there  are  few  cases  which  cannot 
be  materially  relieved.  Chronic  conjunctivitis 
and  coryza,  which  should  be  always  looked  for 
and  attended  to ;  inversion  or  eversion  of  the 
puncta  ;  mucocele,  which  in  turn  depends  on 
stricture  of  the  nasal  duct — these  are  the  usual 
causes.  The  modern  method  of  treating  stric- 
ture by  slitting  the  canaliculi  and  systematic 
probing,  and,  perhaps,  the  temporary  wearing 
of  a  stylet,  has  proved  a  great  advance  upon 
the  old  line  of  treatment,  though  yet  giving  a 
smaller  percentage  of  peraianently  satisfactory 
results  than  the  surgery  of  cataract ;  one  ex- 
planation being  the  fact  that  the  lachrymal 
duct  is  a  bony  canal  with  muco-periosteal 
lining.  Mucocele,  or  chronic  inflammation  of 
lachrymal  sac  (chronic  dacryocystitis),  is  easily 
recognized  by  the  touch  if  not  by  the  eye,  pre- 
senting a  small  doughy  swelling  at  the  inner 
canthus,  pressure  upon  which  causes  regurgita- 
tion of  glairy  mucus  or  muco-pus  into  the  con- 
junctival sac,  or,  rarely,  forces  it  into  the  nose. 
Mucocele  demands  attention  because,  if  neg. 
lected,  slight  exciting  causes  may  light  up 
acute  inflammation,  ending  in  fistula  with 
its  added  annoyance  and  disfigurement.  Merely 
opening  the  canaliculi  into  the  sac,  so  that  the 
latter  can  be  emptied  by  pressure  several  times 
a  day,  instillations  or  injections  of  boracic  acid 
and  zinc  being  then  used,  will  generally  give 
marked  relief  and  also  prevent  an  acute  attack  ; 
and  the  same  course  in  cases  of  fistula  will 
be  followed  by  speedy  healing  of  the  sinus  and 
contraction  of  the  sac  (unless  there  be  bone 
disease),  though  radical  treatment  requires  re- 
lief of  the  stricture.  The  most  troublesome 
epiphora  may  arise  without  mucocele,  stricture, 
or  mal-position  "of  the  puncta,  from  a  tighten- 
ing or  stricture  of  the  tiny  sphincter  at  the 
inner  end  of  the  canaliculi.  Dilatation,  or  divi- 
sion by  a  fine  probe-pointed  knife  gives  marked, 


OF  MEDICAL  SCIENCE. 


259 


if  not  perfect,  relief,  but  is  a  little  feat  sometimes 
more  difficult  of  execiition  than  may  seem. 
Acute  inflammation  of  the  lachrymal  sac  is  some- 
times diagnosed  erysipelas,  owing  to  the  ex- 
tensive inflammatory  oedema  of  the  surrounding 
parts,  involving  the  cheek  and  even  the  lids  of 
the  opposite  side ;  but  the  less  rapid  onset,  and 
the  history,  generally  to  be  had,  of  a  previous 
epiphora  and  mucocele,  and  the  fact  that  pres- 
sure on  the  sac  gives  acute  pain  and  reveals  a 
tense  tumour-like  swelling  will  make  the  dif- 
ferential diagnosis  easy.  A  prompt  opening 
of  the  canaliculi  into  the  sac  will  generally 
abort  the  inflammation  and  give  vent  to  the 
inflammatory  products,  and  later  on  probing 
can  be  instituted.  A  number  of  cases  of 
mucocele  or  fistula  have  occurred  to  me  in  in- 
fants, requiring  operative  treatment,  and  as  a 
rule  resulting  well.  It  should  be  added  that 
chronic  conjunctivitis  with  slight  eversion  or 
atresia  of  the  lower  punctum  will  sometimes 
persist  in  spite  of  the  ordinary  treatment 
unless  the  canaliculus  be  slit,  the  cu<  being 
made  well  on  the  inner  wall,  and  possibly  a 
little  bit  of  conjunctiva  cut  out  in  order  to 
favor  traction  inwards  by  cicatrization. 


A    CASE   OF  PELVIC    HEMATOCELE 
(RETRO-UTERINE). 

BY    H.    P.    HENNINQ,    M.C.P.  ANI>  S.O. 

Mrs.  R ,  set.  28.     Health   had    always 

been  good  ;  a  stout  robust-looking  woman.  A 
day  or  two  before  I  saw  her,  July  25,  1879, 
she  had  fallen  or  jumped  down  a  distance  of 
four  or  five  feet  in  the  barn,  and  now  com- 
plained of  a  severe  sharp  pain  low  down  in 
the  pelvis.  The  fall  occurred  at  the  proper 
time  for  the  recurrence  of  a  menstrual  period. 
There  was  a  good  deal  of  haemorrhage 
from  the  uterus  for  a  few  days ;  was  called 
again  on  July  31,  six  days  afterwards,  the 
haemorrhage  had  nearly  ceased,  but  the  pains 
had  continued  to  increase  in  severity  and  dura- 
tion— one  or  two  hours  at  a  time — and  occur- 
ring two  or  three  times  in  the  twenty-four 
hours.  I  no«r  made  a  thorough  examination, 
both  digital  and  specular,  and  could  find  no- 
thing wrong.  There  was  no  puffiness  about 
the  uterus. 


Saw  the  patient  Aug.  2.  The  paroxysms 
of  very  severe  pain  continued.  There  were 
no  other  symptoms,  except  slight  exhaustion 
from  the  sufiering.  Did  not  make  a  vaginal 
examination  ;  left  opiates,  and  had  the  patient 
rest  in  bed. 

Was  called  again  Aug.  8.  The  only  symp- 
tom yet  was  the  pain,  which  was  increasing  in 
severity,  and  of  longer  duration.  I  now  made 
another  examination  per  vaginam,  .and  dis- 
covered a  large  tumour  behind  and  on  each 
side  of  the  uterus,  pressing  the  latter  forwards. 
Continued  to  treat  the  patient  with  rest,  ab- 
sorbents, and  opiates  until  August  21,  with  the 
result  of  a  large  increase  in  the  tumour,  the 
pain  continuing  very  sevare.  The  os  uteri  was 
pushed  forward  and  upward  almost  out  of 
reach.  I  now  called  to  my  assistance  Dr. 
McCollom,  of  Duunville,  and  we  decided  to  try 
the  efiect  of  further  complete  rest,  with  the 
before-mentioned  medicines. 

This  course  was  pursued  until  Sept.  19.  By 
this  time  the  pain  had  mostly  ceased.  The 
enlargement  had  increased  until  the  os  uteri 
was  completely  out  of  reach,  but  for  the  last 
few  days  had  appeared  about  the  same.  The 
tumour  filled  up  the  pelvis  all  but  the  lower 
part,  and  was  so  hard  that  no  impression  could 
be  made  upon  its  suface  by  the  finger. 

I  now,  Sept.  19,  punctured  the  tumour  near 
the  centre  with  a  large-sized  trocar  leaving  the 
canula,  after  moving  it  about  pretty  freely  to 
break  up  the  clots,  this  being  followed  by  con- 
siderable discharge  of  broken  down  blood  clot. 
I  afterwards  introduced  a  probe-pointed  bistoury 
and  made  an  opening  sufficiently  large  to  admit 
the  finger  and  turn  out  a  good  deal  of  the  clot, 
but  could  not  clear  the  cavity  as  it  was  so  large. 
The  clot  continued  to  break  down  and  come 
away,  was  very  foetid  in  character,  and  the 
patient  began  to  get  chills  and  showed  signs  of 
septicaemia. 

I  now  fitted  a  female  catheter  by  India 
rubber  tubing  six  inches  in  length  to  a  common 
Davidson's  syringe,  and  using  a  proper  solution 
of  glycerine  and  carbolic  acid  in  water — nearly 
a  quart — injected  and  withdrew  the  injection 
repeatedly  until  the  cavity  was  completely 
washed  out  and  the  liquid  returned  clear  (and 
here  let  me  remark  that  there  is  danger  unless 


260 


CANADIAN  JOURNAL 


care  is  taken  of  drawing  the  wall  of  the  cavity 
into  the  fenesti-a  of  the  catheter). 

Great  relief  followed  at  once,  the  chills 
ceased  entirely.  I  continued  to  daily  use  the 
injections  the  same  way  for  a  week,  and  then 
every  second  day  for  another  week,  by  which 
time  the  cavity  was  completely  closed  as  also 
the  opening  made  with  the  knife,  and  the 
patient  soon,  without  further  trouble  than 
consequent  weakness  for  a  time,  regained  her 
usual  health  and  is  now  not  suffering  from  any 
consequence  of  the  hsematocele. 

There  seem  to  be  certain  ])eculiaritie8  about 
this  case  which  differ  from  most  recorded  cases. 
This  was,  no  doubt,  an  extra-peritoneal  htema- 
tocele.  Bernutz  says,  "  The  intra-peritoneal 
is  the  more  common,  and  the  extra-peritoneal 
is  very  rare."  Lawson  Tait  says,  "  That  in 
his  experience  the  latter  is  ten  or  twelve  times 
more  common."  Most  authors  speak  of  the 
tumour  asbeing  "doughy-soft."  Nowthe tumour 
I  speak  of  was  very  hard,  no  impression  could 
be  made  on  it  by  the  finger.  The  last  named 
writer  says  he  has  seldom  seen  any  evidence  of 
repetitive  haemorrhage,  and  never  experienced 
anything  approaching  to  alarm  from  the  im- 
mediate symptoms.  There  was  in  this  case 
repetitive  haemorrhage  for  a  good  many  days 
for  I  had  a  splendid  opportunity  to  watch  the 
process  of  filling  up  and  distension  of  the 
cavity  by  repeated  attacks  of  the  haemorrhage, 
and  the  pain  from  the  distension  and  the  prostra- 
tion were  quite  alarming.  Most  cases  were  said 
to  surround  the  uterus.  In  this  case  there 
was  no  tumour  in  front  of  the  uterus,  which  was 
pushed  up  out  of  reach. 

The  last  named  author  says  :  "  The  majority 
of  cases  of  haematocele  should  be  left  alone,  for 
they  will  become  absorbed  in  greater  part 
though  they  do  not  seem  ever  to  disappear  en- 
tirely," and  goes  on  to  say,  "  I  attended  a  case 
with  Mr.  Brown,  of  Bath  Row,  Birmingham, 
in  which  there  were  no  urgent  symptoms,  and 
which  we  did  not  interfere  with  in  any  way, 
in  about  four  months  it  Ivad  nearly  disappeared, 
leaving  only  tlie  uterus  fixed  on  the  sacrum  ; 
this  seeming  to  be  a  very  common  result  of 
hsematocele. "  And  to  quote  a  little  further, 
"  Occasionally  we  get  cases  of  old  neglected 
hsematocele  which  have  suppurated  and  burst 


into  the  rectum,  the  point  of  election  for  their 
natural  opening,  and  t"hey  will  go  on  diacfiarg- 
ing  quantities  of  pus  for  years,  emhausting  the 
patient  till  a  counter-opening  is  made  in  the 
vagina." 

The  case  I  described  above  could  not  be  left 
alone,  as  the  patient  was  in  a  state  of  extreme 
pain  and  exhaustion.  Then  next,  the  woman 
was  cured  in  less  than  three  weeks  after  opera- 
tion. There  is  no  fixation  of  the  utei-us  to  the 
sacrum,  and  nothing  to  indicate  that  the  woman 
once  had  a  hoematocele.  Would  it  not  be  better 
to  operate  in  such  cases  after  the  attacks  of 
haemorrhage  have  ceased  than  to  leave  a  chance 
for  discharging  quantities  of  pus  for  years,  or 
the  more  harmless  but  still  unwelcome  fixation 
of  uterus  to  the  sacrum  with  loilg  months  of 
illness  and  lying  on  a  hard  bed  1 

CASE  OF  HYDATID  DISEASE  OF  LIVER 
—SPONTANEOUS  CURE  OWING  TO 
CALCAREOUS  DEGENERATION  OF 
THE  CYST. 

Reported  by  W.  G.  Anglin,  Medical  Student. 
The  following  case  is  reported  as  one  rarely 
seen  in  general  practice,  and  will  no  doubt  be 
of  pathological  interest  to  our  readers  : — 

On  the  23rd  May,  1881,  S.  C,  aged  62  yeai-s, 
a  patient  in  the  Asylum  for  the  Insane,  King- 
ston, Ont.,  died  suddenly,  and  seven  hours  after 
death  a  post-mortem  examination  was  made 
to  ascertain,  if  possible,  the  cause  of  death. 
The  patient  was  a  native  of  England,  and  be- 
longed to  the  poorer  classes.  When  young  he 
was  addicted  to  the  use  of  alcoholic  liquors  in 
excess,  and  the  continued  intemperance  had 
much  to  do  with  the  cause  of  his  insanity.  He 
was  admitted  to  the  Asylum  in  March,  1865, 
suffering  from  an  attack  of  acute  mania,  which 
gradually  became  chronic  in  its  character,  and 
continued  without  remission  until  the  patient's 
death.  For  some  time  before  this  event  he  had 
not  been  feeling  well,  but  did  not  complain  of 
any  particular  pain,  and  refrained  from  joining 
the  working  party  on  the  Asylum  farm,  an 
unusual  thing  for  him  to  do,  as  he  was  an  ex- 
ceptionally well-developed  muscular  man,  and 
always  an  active  worker. 

This  illness  was  so  slight  that  he  was  not  pre- 
scribed for,  and  after  a  few  days'  rest  he  re- 


OF  MEDICAL  SCIENCE. 


J61 


sumed  work,  and  the  day  before  his  death  was 
in  remarkably  good  spirits. 

Next  morning,  after  partaking  of  an  umisu- 
ally  hearty  breakfast,  ho  went  down  to  the 
basement  for  a  smoke,  and  not  more  than  five 
minutes  afterwards  was  found  in  a  dying  con- 
dition at  the  door.  The  Assistant  Medical 
Officer  was  immediately  summoned,  but  upon 
reaching  the  spot  found  the  patient  dead.  The 
facial  expression  was  placid  ;  there  was  no  dis- 
colouration of  the  skin  from  capillary  congestion; 
no  frothing  at  the  mouth  or  any  other  evidence 
of  epileptic  seizure ;  no  wounds  or  bruises,  with 
the  exception  of  a  very  slight  scalp  wound, 
supposed  to  have  been  caused  by  falling  from 
his  seat  as  be  became  iinconscious. 

The  autopsy  was  very  minute,  and  yet  no 
apparent  cause  of  death  could  be  made  out,  a 
result  which,  while  it  proved  extremely  unsatis- 
factory, is  not  of  exceedingly  rare  occurrence 
in  cases  of  sudden  death.* 

Without  entering  into  details  of  the  entire 
autopsy,  the  most  important  object  of  patho- 
logical interest  which  presented  itself  will  be 
described.  This  was  found  in  the  liver.  Upon 
passing  the  hand  beneath  the  base  of  the  left 
lung  a  bard,  nodular  mass  was  distinctly  felt 
through  the  diaphragm.  This  at  once  drew  at- 
tention to  the  liver,  which  organ  when  "  in 
situ  "  presented  a  healthy  appearance  and  was 
not  abnormally  large — the  left  lobe,  however, 
projected  further  than  usual  to  the  left  side. 

On  attempting  to  raise  the  left  lobe  it  was 
found  to  be  firmly  attached  to  the  diaphragm 
through  the  intervention  of  this  hard,  globular 
mass  which  could  now  be  distinctly  made  out. 
In  order  to  raise  the  liver  the  adhesions  were 
not  broken,  but  the  adherent  mass  of  liver  and 
diaphragm  was  removed. 

When  placed  upon  the  scales,  the  whole  or- 
gan, with  a  small  piece  of  attached  diaphragm, 
was  found  to  weigh  fifty-five  ounces.  The 
general  appearance  was  healthy,  but  the  dis- 
covery of  the  morbid  growth  before  mentioned, 
as  well  as  two  calcareous  bodies,  each  about  the 
size  of  a  pea,  made  the  examination  one  of  great 
interest. 

The  cystic  tumour  found  in  the  left  lobe  was 
nearly  round,  very  hard,  of  a  dirty-white  color, 

*Delafield  on  Post-Mortems 


and  looked  like  an  ordinary  billiard  ball.  It 
was  one  and  three-quarter  (1|)  inches  in  diame- 
ter, attached  firmly  by  its  upper  surface  to  the 
diaphragm  and  free  on  its  lower  side,  being 
partly  encircled  by  the  substance  of  the  liver 
and  projecting  slightly  from  the  left  extremity. 

At  the  time  of  the  post-m9rtem  examination 
it  was  impossible  to  determine  the  nature  of  the 
tumour,  but  minute  investigation  of  the  foreign 
body  revealed  the  following  facts,  viz  : — 

First, — That  the  tumour  was  cystic  in  it  char- 
acter. 

Secondly, — That  it  was   of  parasitic  origin. 

Thirdly, — That  the  parasites  had  perished 
and  undergone  a  process  of  degeneration. 

The  wall  of  the  cyst  was  calcareous,  hard,  and 
brittle,  being  of  variable  thickness,  from  one- 
sixteenth  to  one-eighth  of  an  inch  thick.  The 
contents  were  of  a  putty -like  consistence,  hav- 
ing evidently  undergone  transformation  and 
become  atheromatous — deeply  stained  with  bile, 
and  had  an  ofiensive  odor.  Small  fragments 
of  calcareous  matter  were  also  present. 

A  microscopical  examination  of  the  contents 
was  made  with  the  following  result : — Large 
numbers  of  crystals  of  cholest^rine  and  haema- 
toidine  were  to  bj  seen  under  a  ^th  objective, 
and  booklets  of  the  •"  echinococcus  "  were  dis- 
tinctly visible,  both  separately  and  in  groups  of 
three  or  four. 

The  booklets  were  not  numerous,  but  to  be 
seen  in  sufficient  quantity  to  establish  beyond  a 
doubt  the  origin  of  the  tumour. 

This  form  of  tumour  is  of  very  rare  occurrence 
in  this  country,  and  the  spontaneous  cure 
efiected  by  the  calcareous  degeneration  of  the 
coats  of  the  cyst  proved  a  fortunate  thing  for 
the  patient. 

*  Frerichs  remarks  that  he  has  seen  a 
hydatid  cyst  of  the  size  of  a  goose-egg,  complete- 
ly surrounded  on  all  sides  by  a  calcareous  shell 
from  2  to  3  lines  thick. 

It  may  be  mentioned  that  in  the  examination 
of  the  brain,  the  coats  of  the  majority  of  the 
vessels  were  filled  with  an  atheromatous  deposit 
and  atheroma  of  the  basilar  artery  was  particu- 
larly noticeable. 

Also,  as  hydatid  disease  of  the  liver  and 
lungs,  and   more   especially  of  the  liver  and 

*Reynolds'  System  of  Medicine.     Vol.  III.,  p.  393. 


262 


CANADIAN  JOURNAL 


spleen,  are  said  frequently  to  co-exist,  it  may  be 
well  to  state  that  both  these  organs  were  thor- 
oughly examined  and  found  to  be  in  an 
apparently  healthy  condition,  no  trace  of 
disease  being  observable. 


TREATMENT  OF  PERITONITIS. 

BY  A.  m'pHEDRAN,  M.B., 

Physician  to  the  Toronto  Dispensary. 

(Read  before  the  Medical  Society.) 
Quinine  has  the  power  of  arresting  inflam- 
mation if  given  before  migration  of  the  white 
corpuscles,  or  proliferation  of  the  cellular  ele- 
ments of  the  inflamed  tisstie  has  taken  place, 
but  is  powerless  to  prevent  the  further  })rogress 
of  the  disease  after  the  occurrence  of  «these  pro- 
cesses as  it  cannot  cause  the  disintegi'ation  and 
absoi-ption  of  inflammatory  products.  The  ad- 
dition of  mocphia  greatly  increases  the  utility 
of  quinine  in  this  direction.  Therefore,  in  a 
case  of  threatening  peritonitis,  or  one  in  the 
initial  stage,  an  efibrt  should  be  made  to  arrest 
the  disease  by  the  administration  of  two  or 
three  large  doses  of  quinine,  about  twenty 
grains  each. 

Opium  is  the  most  important  of  all  remedies 
in  inflammation,  and  is  of  special  utility  when 
the  serous  membranes  are  affected.  It  relieves 
pain,  allays  excitement,  quiets  restlessness,  and 
gives  sleep,  thus  lessening  the  depression  of  the 
vital  forces.  By  adding  to  the  tone  of  the  blood- 
vessels it  aids  in  maintaining  the  blood  current 
and  hindering  the  migration  of  the  white  cor- 
puscles. Bartholow  says  there  is  good  reason 
to  believe  that  the  early  administration  of 
opium  will  cut  short  an  attack  of  inflammation 
of  the  serous  membranes;  if  the  disease  is  too 
far  advanced  to  effect  that  purpose,  it  will 
modify  materially  its  course  and  duration.  It 
is  in  peritonitis  that  the  curative  powers  of 
opium  are  specially  evident.  Besides  its  con- 
stitutional effect  it  stops  all  peristalsis  of  the 
bowels,  thus  securing  complete  rest,  the  most 
essential  element  in  the  treatment  of  all  acute 
inflammations.  To  obtain  this  desired  result, 
the  opiate  must  be  given  in  such  doses,  irrespec- 
tive of  the  amount,  as  are  needed  to  keep  the 
patient  in  a  state  bordering  on  narcotism,  as 
shown  by  the  abscence  of  pain,  the  slow  respira- 


tion, and  the  somnolency  from  which,  however, 
he  should  always  be  easily  roused,  lest  the  effect 
of  the  opiate  be  carried  too  far.  This  condition 
is  to  be  maintained  till  the  last  trace  of  the 
disease  has  disappeared,  as  relapse  is  liable  to 
follow  too  early  suspension  of  the  opiate. 
Fordyce  Bai-ker,  in  his  admirable  treatise  on 
Puerperal  Diseases  says,  he  has  often  had  to 
continue  the  opiate  for  a  week  or  two  after  the 
abdominal  pain,  tenderness  and  tympanites  had 
disappeared,  because  the  appetite  did  not  re- 
turn, and  the  pulse  continued  quick  and  tem- 
perature high.  Morphia  is  the  best  form  in 
which  to  give  the  opiate,  and  is  best  admin- 
istered by  the  stomach,  as  the  hypodermic  in- 
jection usually  causes  considerable  excitement, 
and  this  should,  if  possible,  be  avoided.  If  the 
stomach  reject  the  medicine  then  it  may  be 
given  hypodeimically  till  quiet  is  restored. 
There  is  often  remarkable  tolerance  of  opium 
in  peritonitis.  In  a  case  recorded  in  Barker's 
work,  above  referred  to,  over  80  grs.  of  sulphate 
of  morphia  were  administered  in  24  hours,  and 
other  cases  are  reported,  in  which  quantities 
almost  as  large  were  borne. 

It  is  of  great  importance  to  allay  the  vascular 
excitement  in  peritonitis  as  it  tends  to  rapid 
depression  of  the  vital  powers.  In  vigorous 
patients,  with  a  full  strong  pulse,  the  most 
effectual  means  for  attaining  this  end  is  vene. 
section.  In  the  Lancet  (1859),  a  case  is  recorded 
by  Erichsen  of  acute  peritonitis  and  pleuritis 
from  injury  that  yielded  at  once  to  venesection, 
twenty-four  ounces  of  blood  being  drawn.  AH 
evidence  of  inflammation  had  disappeared  in 
less  than  six  days.  But  in  the  great  majority 
of  cases  the  patients  are  not  sufficiently  vigor- 
ous to  render  recourse  to  the  lancet  advisable ; 
in  these  cases  the  vascular  excitement  must  be 
quieted  without  loss  to  the  vital  powers.  Two 
remedies  meet  the  requirements  very  efficiently 
— aconite  and  veratrum  viride.  Both  act  as 
depressents  to  the  vaso-motor  centres.  Aconite 
dilates  the  arterioles,  doubling  their  capacity, 
and  thus  relieves  the  congestion  of  the  inflamed 
part  ororgan — "bleeds  the  patients  into  himself" 
(Fothergill.)  It  appears  to  be  more  effectual 
in  small  inflammations  as  tonsillitis.  It  must 
be  given  in  small  doses  (1  to  2  gtt)  and  re- 
peated frequently — in  most  cases  hourly,  and 


OF  MEDICAL  SCIENCE. 


263 


sometimea  it  may  be  given  every  fifteen  minutea 
for  a  few  doses  with  advantage.  Veratrum 
viride  causes  contraction  ®f  the  arterioles  un- 
less given  in  lethal  doses,  and  would,  therefore, 
probably,  have  no  local  effect  on  the  inflamed 
part,  similar  to  aconite.  It  should  be  given  in 
3-5  m.  doses,  and  repeated  hourly  till  the  pulse 
is  reduced  to  80  in  the  minute,  and  continued 
in  such  quantities  as  are  necessary  to  maintain 
about  this  rate  of  pulse.  Either  medicine  re- 
quires careful  and  intelligent  administi*ation  to 
be  of  much  service ;  given  in  a  haphazurd 
fashion  it  would  be  useless,  if  not  dangerous. 

If  the  rapid  pulse  is  due  to  exhaustion,  in- 
stead of  these  depressants,  stimulants,  especially 
the  alcholic,  are  indicated  to  slow  and  strengthen 
the  pulse  and  maintain  the  powers  of  the 
patient  past  the  critical  period.  They  should 
not  be  delayed  too  long,  nor  given  too  sparingly, 
as  the  tendency  in  peritonitis  is  to  rapid  asthenia. 
Alochol  increases  the  supply  of  blood  to  the 
brain,  promotes  digestion  and  assimilation,  and 
diminishes  the  waste  of  tissue  (Beale)  ;  it  is, 
therefore,  of  the  greatest  utility  in  all  acute 
diseases  in  which  waste  greatly  exceeds  assimi- 
lation. 

Vomiting  is  frequently  a  troublesome  com. 
plication ;  it  indicates  inflammation  of  the 
serous  coat  of  the  stomach,  as  frequent  painful 
micturition  does  that  of  the  serous  coat  of  the 
bladder.  It  should  <be  treated  by  morphia 
hypodermically  and  ice,  hydrocyanic  acid, 
bismuth,  etc.,  by  the  mouth.  If  the  vomiting 
persists,  and  is  frequent  and  bilious,  Fordyce 
Barker  advises  giving  10  grains  of  calomel, 
well  rubbed  up  with  20  grains  of  bicarbonate 
of  sodium.  This  will  cause  two  or  three  free 
watery,  usually  painless,  evacuations  from  the 
bowels ;  they  usually  relieve  the  vomiting. 
The  peristalsis  of  the  bowels,  caused  by  the 
calomel,  cannot  do  as  much  injury  to  the  in 
flamed  structures,  as  the  movement  of  the 
stomach  in  the  persistent  vomiting.  Purgatives 
are  advisable  under  no  other  conditions.  As 
much  nourishment  as  possible  should  be  taken, 
chiefly  fluid,  and  in  small  quantities  at  short 
intervals,  especially  if  there  is  a  tendency  t^ 
vomiting. 

Turpentine  applied  to  the  abdomen  is  of  great 
service  in  relieving  the  pain  and  tympanitea 


It  is  best  iipphed  sprinkled  on  two  or  three 
layers  of  flannel  promptly  wrung  out  of  hot 
water.  It  seldom  can  be  borne  longer  than 
twenty  minutes  ;  on  removing  the  flannel  the 
abdomen  should  be  covered  with  cotton  wool, 
over  which  laudanum  may  be  freely  sprinkled 
to  allay  the  burning  pain  caused  by  the  turpen- 
tine. The  application  should  be  repeated  as 
often  as  it  can  be  borne.  The  effect  is  usually 
to  lessen  the  tympanites  and  improve  the 
general  condition  of  the  patient  as  shown  by 
moistening  of  the  tongue  and  skin,  fuller  pulse, 
and  less  anxious  countenance.  This  may  be 
due  simply  to  the  counter-irritant  effect,  or 
possibly  to  absorption  of  some  of  the  turpentine. 
For  the  typhoid  state  turpentine  is  an  excellent 
stimulant.  From  five  to  fifteen  drops  my  be 
given  on  lump  sugar  or  in  emulsion.  The  ex- 
istence of  tympanites  is  an  additional  indica- 
tion for  its  administration  in  peritonitis. 

The  utmost  quiet  should  be  enjoined  on  the 
patient.  No  unnecessary  movement,  active  or 
passive,  should  be  permitted.  If  much  strain- 
ing is  needed  to  empty  the  bladder  a  catheter 
should  be  used. 

In  the  discussion  that  followed  the  President 
referred  to  several  cases  of  peritonitis  he  had 
had  in  his  practice,  and  pointed  out  the  great 
benefit  derived  from  the  administration  of 
turpentine  and  carbonate  of  ammonia,  when 
there  was  much  prostration. 

Dr.  Oldright  had  given  veratrum  viride 
and  found  it  the  most  effective  remedy  in  allay, 
ing  vascular  excitement. 


Gelsemium  in  Rhus  Poisoning. — Dr.  Ben- 
jamin Edson,  of  Brooklyn,  recommends  {New 
York  Medical  Journal)  the  following  wash  for 
the  rapid  relief  of  symptoms  produced  by 
poison  ivy  : — R.  Acid  carbol.  58S ;  ext.  gelsem. 
fluidi  5ii ;  glycerini  333  ;  aquae,  ad.  giv  Tl| , 
With  this  cloths  are  to  be  kepi  moistened  and 
applied  to  the  parts  affected.  Internally  the 
fluid  extract  of  gelsemium  in  two  minimum  doses 
every  three  hours.  Thirty-six  hours  sufficed 
to  control  the  symptoms. 

The  idea  that  iron  is  an  analeptic  has  come 
to  an  end.  Alimentation  is  more  than  sufficient 
to  furnish  the  two  or  three  gi'ams  of  iron 
which  are  contained  in  the  totality  of  an  adult's 
blood. — Dr.  Luton,  in  L'  Union  M^cKcale. 


264 


CANADIAN  JOURNAL 


Mt(tim»:  pdiduf. 


AN  ABSTRACT  OF  REMARKS  ON  THE 
PRACTICAL  SIGNIFICANCE  OF 
CRYSTALLINE  AND  OTHER  URIN- 
ARY SEDIMENTS,  EXCEPT  TUBE- 
CASTS. 

Read  before  the  Clinical  Section  of  the  Philadelphia 
County  Medical  Society,  January  31,  1882. 

BY   JAMES    TYSON,    M.D. 

In  the  first  place,  no  crystalline  or  other 
urinary  sediments  are  of  any  significance  unless 
they  are  present  in  urine  at  the  time  it  is  passed 
or  immediately  thereafter.  Nor  can  the  occa- 
sional appearance  of  these  sediments  have  any 
significance.  They  should  occur  continuously, 
or  at  least  for  several  days  in  succession. 

Secondly,  of  the  urinary  sediments  referred 
to,  I  will  consider  only  the  following  : 

1.  Uric  acid  and  urates. — They  indicate  in- 
sufficient ingestion  of  fluids,  imperfect  oxidation 
of  the  proximate  principles  which  go  to  make 
up  food,  or  excessive  acidity  of  the  urine  as  the 
result  of  which  they  are  precipitated.  Such 
conditions  may  result  in  the  undue  accumulation 
of  these  substances  in  the  blood,  or  their  de- 
posit as  sediments  in  certain  parts  of  the  urin- 
ary passages,  as  the  pelvis  of  the  kidney, 
ureters  and  bladder,  in  such  quantities  as  to 
form  calculous  aggregations  with  the  symptoms 
which  usually  attach  to  them. 

The  former — that  is,  undue  accumulation  in 
the  blood — gives  rise  to  gout  or  the  condition 
to  which  the  name  lithsemia  has  been  applied, 
and  of  which  the  symptoms  have  been  well 
described  by  Da  Costa  in  a  recent  paper.  ^ 

Uric  acid  is  very  easily  recognized  by  the 
rhombic  shape  or  some  one  of  its  variations ; 
if  there  is  any  doubt  about  any  of  these  forms, 
it  may  be  removed  if  it  be  remembered  that 
uric-acid  crystals  are  invariably  stained  yellow, 
which  is  true  of  no  other  crystalline  sediment 
of  the  urine  except  the  urate  of  ammonium 
which  exists  only  in  spherules  similarly  col- 
oured, but  by  their  shape  easily  distinguished. 
Amoipbous  urates  of  sodium  and  potassium, 
which  frequently  accompany  uric  acid,  may  be 
recognized  by  their   pink,  fawn,  or  brick-dust 

*  American  Journal  of  the  Medical  Sciences,  October,  1881. 


hue,  and  their  solubility  by  warmth.  In  form 
they  are  not  distinguishable  from  any  other 
amorphous  matter. 

A  good  method  of  dissolving  amorphous 
urates — which  often  fall  in  cold  weather  during 
the  transit  of  a  specimen  from  the  patient's 
house  to  the  doctor's  office,  and  make  the  detec- 
tion of  other  more  important  sediments  difficult 
— is  to  place  the  bottle  for  a  few  minutes  in  a 
pitcher  of  hot  water. 

The  treatment  of  uric-acid  and  uratic  sedi- 
ments is  by  diluents  of  an  alkaline  or  even 
neutral  reaction.  The  citrates,  acetates,  and 
carbonates  of  the  alkalies,  freely  diluted,  in 
most  instances  speedily  dissipate  these  sedi- 
ments. Even  the  use  of  a  quart  of  plain  water 
in  addition  to  that  ordinarily  ingested  in  the 
twenty-four  hours  will  have  the  desired  effect. 
And  I  am  certain  that  the  effect  of  the  chem- 
ically-indifferent mineral  waters  which  are  so 
much  advertised  and  consumed  in  this  country 
is  due  to  the  dilution  they  afford. 

With  regard  to  tbe  solution  of  uric-acid 
calculi  in  the  urinary  passages,  the  experimen- 
tal researches  of  Roberts,  of  Manchester,  Eng- 
land, have  shown  that  by  the  administration  of 
alkalies,  it  is  at  least  possible  to  prevent  them 
from  growing  larger.  Elimination  by  aperients, 
especially  by  the  natui-al  aperient  mineral 
waters,  as  Hunyadi  and  Friedrichshalle,  is  effi- 
cient in  relieving  the  kidneys  of  a  part  of  their 
woik. 

2.  Sediments  of  oxalate  of  Urns,  which^  are 
readily  recognized  by  'heir  octahedral  and 
dumb-bell  forms,  are  also  the  result  of  mal-as- 
similation,  indigestion,  or  the  ingestion  with 
the  food  of  substances  containing  large  amounts 
of  oxalic  acid,  as  the  pie-plant,  sorrel,  and  to- 
matoes. Their  significance  also  depends  upon 
their  permanence.  If  permanent  or  sufficiently 
abundant,  they  may  cause  irritation  of  the 
urinary  passages  similar  to  that  resulting  from 
uric-acid  accretions. 

The  treatment  of  oxalate-of-lime  sediments 
is  that  of  the  mal-assimilation  and  indigestion 
of  which  they  are  the  symptoms.  A  solvent 
treatment  of  oxalate-of-lime  calculi  in  the  body 
is  admitted  to  be  impossible,;  but  the  same 
method  of  treatment  which  tends  to  prevent 
the  formation  of  uric-acid  sediments  will  pre- 


OF  MEDICAL  SCIENCE. 


265 


vent  the  formation  of  oxalates,  as  they  are  both 
the  result  of  the  same  conditions. 

3.  Phospliatic  sediments.  — These  include  the 
crystalline  triple  phosphate,  phosphate  of  lime, 
and  amorphous  phosphates.  They  occur  only 
in  alkaline  urine,  and  if  present  when  the  urine 
is  passed  or  soon  thereafter — when  alone  they 
are  of  any  significance — they  indicate  that  the 
urine  is  alkaline  at  such  time.  The  result  of  a 
constant  condition  of  this  kind,  which,  it  is  im- 
portant to  remember,  may  occur  from  the  ex- 
cessive administration  of  alkaline  remedies, 
may  be  phosphatic  accretions  in  the  urinary 
passages.  These  may  occasion  the  same  symp. 
toms  of  irritation  as  those  of  uric-acid  and 
oxalates. 

As  to  treatment,  it  is  acknowledged  to  be  im- 
possible to  produce  by  medication  such  a  degree 
of  acidity  of  the  urine  as  will  dissolve  phos- 
phatic accretions  of  any  size ;  but  here,  again, 
the  natural  acid  reaction  of  the  urine  may  be 
restored  and  kept  up  by  the  administration  of 
benzoic  acid,  which  is,  in  my  experience,  the 
only  remedy  to  be  relied  upon  for  this  purpose. 
Phosphatic  sediments  often  accompany  the  ])us 
and  mucus  which  are  the  result  of  inflammation 
of  the  bladdei",  but  it  is  questionable  whether 
they  as  sediments  add  to  the  inconvenience  of 
these  affections.  This  is  chiefly  due  ta  the  vis- 
cid, glairy  product  of  the  action  of  alkalies  on 
pus,  which  is  the  principal  cause  of  the  difficult 
and  painful  micturition  which  attends  this 
condition. 

Serious  errors  in  practice  are  often  made  by 
the  administi'ation  of  alkaline  mineral  waters 
in  these  conditions  of  phosphatic  sediments, 
these  waters  being  indiscriminately  resorted  to 
in  all  bladder  affections,  without  regard  to  ac- 
curate diagnosis. 

4.  Urate  of  ammonium  appears  in  the  shape 
of  yellow  spheres  in  urine  of  alkaline  reaction, 
under  the  same  circumstances  as  those  un<ler 
which  the  phosphates  are  found. — Philadelphia 
Medical  Times. 

RoTHELN. — Dr.  Block  (Hospitals  Tidende, 
February  8,  1882),  attaches  great  diagnostic 
importance  to  the  swelling  and  tenderness  of 
the  lymphatic  glands,  especially  of  the  post 
cervical  glands.  This  may  occur  during  the 
prodromal  stage,  and  will  then,  Block  is  inclined 
to  think,  furnish  a  valuable  means  of  differen- 
tial diagnosis  between  rubeola  and  rbtheln. — 
Chicago  Medical  Review. 


VARIOLA  AND   THE  ANTISEPTIC    OF 
M.  PENNES. 

BY    P.    H.    BRYCE,    M.A.,    M.D.,    TOKONTO. 
Journal  D'Hygiene,  Paris. 

In  the  review  of  the  Exposition  of  Sciences 
Applied  to  Industry,  we  have  noticed  that  the 
judges  awarded  a  dij)loma  to  M.  Penn^s  for 
the  great  variety  of  zoological  preparations 
preserved  by  his  vinegar,  composed  of  salicylic 
acid  and  eucalyptus  as  the  principal  bases. 

The  successes  which  this  new  product  has 
met  with,  in  some  twenty  hospitals  in  Paris, 
under  the  control  of  the  most  prominent  med- 
ical men,  have  already  awarded  it  a  worthy 
recompense. 

Now,  we  recognize  with  pleasure  that  this 
antiseptic  of  Pennds  has  realized  a  real  advance 
in  the  treatment  of  variola^  which  continues  to 
make  ravages,  both  in  private  abodes  and  in 
the  hospitals  of  Paris. 

In  the  words  of  one  of  the  most  distinguished 
physicians  of  the  St.  Louis  : — "  The  Vinaigre  de 
Pennes  has  realized,  in  our  hands,  the  most 
brilliant  expectations  that  its  chemical  com- 
position has  allowed  us  to  conceive  of.  For 
nearly  six  months  we  have  had  recourse  to 
this  powerful  therapeutic  agent  in  our  service 
of  small-pox  at  the  hospital  of  St.  Louis,  and 
we  cannot  sufficiently  praise  the  brilliant 
results  which  it  has  given  us  in  its  various 
methods  of  application. 

1st.  Employed  in  the  form  of  pulverization 
with  the  aid  of  Lister's  apparatus,  and  follow- 
ing the  same  methods  as  for  the  carbolic  spray, 
the  Vinaigre  de  Pennes,  reduced  by  five  times 
its  weight  of  water,  has  served  us  as  a  means 
of  disinfection  in  our  small-pox  wards. 

2nd.  The  jet  of  antiseptic  spray,  directed 
upon  the  face  and  the  skin,  facilitates,  in  a 
remarkable  degree,  the  detachment  of  the 
crusts  which  the  varioloid  pustules  leave  after 
ihem,  and  masks  the  smell,  sometimes  so  repul- 
sive, which  is  exhaled  from  the  bodies  of  such 
patients.  It  is,  especially  in  the  after-stages  of 
small-pox,  and  principally  in  those  of  desicca- 
tion, that  this  spray  renders  the  greatebt  ser- 
vice. To  the  action  produced  by  the  vapour 
upon  the  crusts  is  added,  in  effect,  the  action 
which  is  exerted  upon  the  subjacent  surfaces, 


266 


CANADIAN  JOURNAL 


the  cicatrizatiou  of  wLich  is  manifestly  hastened. 
The  patients  are  fond  of  the  spray  and  ask  fin- 
it.  The  odour  of  this  antiseptic  is  agreeable 
and  pleasant. 

The  spray  begun  early,  from  the  tentli  to 
twelfth  day  of  a  coherent  variola,  and  directed 
specially  npon  the  face  of  the  patient,  is 
repeated  four  or  five  times  during  the  day  ;  it 
thus  prevents  patients  from  scratching  by 
allaying  the  uneasiness,  and  effaces,  by  favour- 
ing cicatrization,  the  hideous  marks  which  the 
disease  so  often  leaves  after  it. 

These  antizymotic  vapours  have,  moreover, 
the  merit  of  preventing,  when  frequently  re- 
newed, those  saillies  verruqueuses,  true  po?t- 
varioloid  condylomata,  so  frequent  upon  the 
face,  and  so  slow  in  disappearing. 

3rd.  It  often  happens  that  patients  aie  taken 
to  the  hospital  in  a  carriage,  this  vehicle  thus 
becoming  one  of  the  sui-est  means  of  contagion. 
Hence,  should  there  not  be  an  immediate  appli- 
cation of  this  prophylactic  vapour  to  it  ?  We 
have  been  accustomed  to  spray  the  carriage 
with  it. 

4th.  The  vinaigre  de  Pennes  has  equally 
rendered  service  as  a  lotion  in  baths  for 
cleansing  the  ulcerated  surfaces  so  frequently 
following  the  opening  of  abscesses — frequent 
in  the  later  stages  of  small-pox. 

In  a  word,  this  new  agent  appears,  to  us,  to 
realize  a  true  progress  in  the  prophylactic 
treatment  of  contagious  diseases,  parasitic  or 
zymotic,  and  we  are  happy  to  be  able  to  denote 
here  the  principal  indications  for  its  employ- 
ment, and  the  benefits  following  its  use. — Dr. 
Lnhadie-Lagrave,    Medecin    des     Hdpitaux  de 

Paris. 

«  m^m  . '■ — 

Administration  of  Oil  op  Turpentine. — 
Ordinary  sulphuric  ether  has  the  property  of 
modifying  the  persistently  unpleasant  flavour 
of  oil  of  turpentine.  The  following  mixture 
has  been  found  very  beneficial  in  vesical  catarrh, 
neuralgia,  and  sciatica  : — 

R  01.  terebinth ^'j- 

-4Cther  sulphur 5j- 

Mix  by  shaking  violently,  and  add  : 

Syr.  aurant.  flor ^. 

Aquse ^iv. 

M.  S. — Teaspoonful  every  2  hours. — Druggists' 
Circular. 


KOCH  AND  THE  INFECTIVE  ELEMENT 
IN  TUBERCULOSIS. 

Ever  since  Villemin,  more  than  fifteen  years 
ago,  claimed,  as  the  result  of  his  experiments 
on  the  lower  animals,  that  tubercle  was  a  specific 
disease,  duo  to  a  special  virus,  almost  endl<-ss 
experiments  have  been  made  in  diff*erent  parts 
of  the  world  to  test  the  validity  of  his  state- 
ments. The  outcome  of  their  conjoined  labors 
has  placed  the  matter  in  a  somewhat  new  light, 
for  while  it  has  been  determined  with  great  ac- 
curacy that  the  miliary  granulum  is  a  product 
of  inflammation,  it  has  also  been  shown,  with 
aljout  as  much  certainty,  that  various  org  mic 
substances  may  produce  it,  and,  therefore,  to  a 
certain  extent  it  may  be  classed  among  the  in- 
fective diseases  These  results  have  been  de- 
rived from  the  studies  of  Fox,  Sanderson,  Clarke, 
Cohnheim,  Salomonsen,  and  Buhl.  Those, 
however,  who,  like  Cohnheim,  Klebs,  and  Koch, 
maintain  that  the  tubercle  granulum  is  due 
solely  to  the  interposition  of  a  specific  virus, 
have  naturally  hunted  for  it  with  their  micro- 
scopes, but  thus  far  when  one  has  proclaimed  a 
discovery  he  has  obtained  little  credence,  be- 
cause these  alleged  discoveries  have  almost  in- 
variably proved  premature.  The  latesb  an- 
nouncement comes  from  Robert  Koch,  who  has 
recently  received  an  appointment  as  advisory 
councillor  in  the  Sanitary  Department  in  Ber- 
lin. He  claimed  by  using  aniline  dyes  to  have 
b  en  able  to  colour  certain  minute  bacterial  or- 
ganisms found  in  tuberculosis,  and  he  is  pre- 
pared to  affirm  that  they  are  the  essential 
elements  that  cause  infection. 

The  dyes  in  question  are  methyl-blue  and 
vesuvin,  which  cause  peculiar  staining,  differ- 
entiating them  from  the  ordinary  bacteria  of 
decomposition  that  take  a  purple  colour  with 
hajmatoxylin.  His  method  is  as  follows  :  A 
methyl-blue  fluid  is  made,  which  consists  of  1 
c.c.  of  a  concentrated  alcoholic  solution  ot 
methyl-blue  in  200  c.c.  of  distilled  water,  to 
which  0.2  c.c.  of  a  10  per  cent,  caustic  soda 
solution  has  been  added.  The  preparations  re- 
main in  this  mixture  from  twenty  to  twenty- 
four  hours,  or,  if  they  are  kept  at  a  temperature 
of  104°  F.  in  the  water-bath,  the  time  may  be 
reduced  to  a  halfhour.     Then    the  same  pre- 


OF  MEDICAL  SCIENCE. 


267 


parations  are  flooded  with  a  concentrated  watery 
solution  of  vesuvin,  and  two  minutes  later  are 
washed  with  distilled  water.  All  animal  tissues 
and  oi'dinary  bacteria  are  now  said  to  be  stain- 
ed brown  (lepra  bacilli  excepted),  but  the  tu- 
bercular parasite  is  coloured  blue. 

He  further  announces  that  he  has  been  able 
to  isolate  these  lacberia  from  the  others  with 
which  they  are  found,  by  successive  cultures  in 
the  well-known  sterilized  fluids.  He  regards 
these  bacteria  as  different  from  those  that  have 
been  described  by  Klebs,  Scbuller,  or  Aufrecht. 
His  experiments  have  been  very  numerous. — 
Cincinnati  Medical  News. 


AMYLOID  KIDNEY  WITHOUT 
ALBUMINURIA. 

J.  Straus  concludes  a  paper  on  amyloid  kid- 
ney without  albuminuria,  as  follows  : — 

1.  In  certain  cases  of  amyloid  degeneration 
of  the  kidneys,  albuminuria  may  be  constantly 
absent  until  death. 

2.  The  absence  of  albuminuria  is  due  on  the 
one  hand  to  the  absence  of  a  deep  lesion  (inter- 
stitial or  epithelial)  of  the  kidney,  and  ou  the 
other  hand  to  a  special  localisation  of  the 
amyloid  degeneration.  This,  in  such  cases, 
bears  chiefly  upon  the  vasa  recta  of  the  medul- 
lary substance  and  implicates  in  a  minor  de- 
gree the  glomerular  vessels. 

3.  From  a  clinical  point  jf  view,  if  in  a 
phthisic,  or  an  inveterate  syphilitic,  or  a  subject 
of  chronic  osseous  suppuration,  etc.,  we  find 
enlargement  of  the  spleen  and  of  the  liver,  but 
without  albuminuria,  we  are  not  justified  on 
this  account  in  rejecting  the  idea  of  amyloid 
degeneration  of  the  viscera,  nor  even  in  abso- 
lutely denying  amyloid  degeneration  of  the 
kidneys. 

i.  Those  authors  who  date  the  beginning  of 
amyloid  degeneration  in  the  economy  from  the 
moment  at  which  they  observe  the  presence  of 
albumen  in  the  urine,  commit  a  double  error, 
(a)  because  amyloid  degeneration  is  far  from 
beginning  always  by  invading  the  kidneys.  On 
the  contrary,  the  spleen  and  the  liver  are 
habitually  the  first  to  be  attacked,  (6)  because 
the  kidney  itself  may  be  suffering  from  amyloid 


degeneration  without  albuminuria  being  pre- 
sent. It  is  then  necessary  to  mistrust  calcula- 
tions by  which  it  has  been  sought  to  fix  the 
possible  duration  of  life  in  subjects  afilicted 
with  amyloid  cachexy,  by  making  this  date  from 
the  first  appearance  of  albuminuria. — U Union 
Medical. 


FORCED  FEEDING  IN  PHTHISIS. 

We  recently  called  attention  to  the  proposal 
of  M.  Debove  to  treat  cases  of  phthisis  at- 
tended with  vomiting,  &c.,  by  forced  feeding 
with  the  stomach  pump,  and  the  subject  was 
again  brought  before  the  Soci^td  Medicale  des 
Hopitaux,  on  Apiil  14th  by  M.  Dujardin- 
Beaumetz,  who  had  at  fii'st  met  with  little 
success,  in  consequence,  he  believed,  of  having 
Employed  raw  meat  and  eggs.  M.  Debove,  on 
the  other  hand,  transforms  the  food  into  im- 
palpable powder  before  administering  it  to  his 
patients.  This  M.  Beaunietz  has  given  in  a 
daily  quantity  of  200  grammes,  which  cor- 
respond to  600  grammes  of  raw  meat,  and  he 
has  obtained  by  this  means  the  same  results 
as  M.  Debove — progressive  fattening  and 
general  amelioration,  especially  in  hysterical 
patients  with  almost  intractable  vomiting, 
which  ceased  completely  under  the  new  method 
of  treatment,  although  if  ordinary  feeding  by 
the  mouth  were  attempted  the  vomiting  re- 
appeared at  once,  as  if  excited  by  a  pharyngeal 
spasm,  the  result  of  the  passage  of  the  food 
down  the  throat.  M.  Debove  stated  that  all 
the  phthisical  patients  treated  by  this  method 
were  doing  admirably,  fattening  in  a  remarkable 
manner,  some  having  gained  twelve  kilogram- 
mes in  a  month,  and  most  of  them  seemed  in  a 
fair  way  towards  recovery.  One  of  the  patients, 
however,  having  obtained  permission  to  go  out 
for  a  couple  of  hours,  under  the  promise  of 
taking  no  alcohol,  had  employed  the  time  in 
such  pleasures  of  another  kind  that  he  returned 
with  absolute  retention  of  urine,  and  the  neces- 
sary surgical  treatment  resulted  in  his  death* 
The  subsequent  postmortem  examination 
showed  that  the  large  cavities  in  the  lungs 
were  lined  with  granulations,  and  in  full 
process  of  healing. — London  Lancet. 


268 


CANADIAN  JOURNAL 


TREATMENT  OF  ACUTE  DYSENTERY 
WITH  ACONITE. 

Dr.  Win.  Owens  reports  151  cases  of  acute 
dysentery  occurring  in  the  Convict  Hospital, 
Port  Blair,  India,  which  were  treated  with 
tincture  of  aconite  ;  all  the  cases  were  typical 
examples  of  acute  dysentery,  and  all,  with  one 
exception,  recovered.  He  states  that  he  was 
led  to  give  aconite  a  trial,  as  the  remedy  most 
likely  to  be  successful,  fxom  the  following 
considerations  : — 

(1)  From  its  beneficial  action  in  other  acute 
iniiainmations. 

(2)  From  its  effect  on  the  capillaries  of  the 
skin,  which  it  dilates,  thus  relieving  internal 
congestion. 

(3)  From  its  antipyretic  acti  m  in  febrile 
cases. 

(4)  From  its  sedative  action  on  the  mucous' 
membrane  of  the  stomach  and  intestines,  and 
its  beneficial  action  in  some  forms  of  dyspepsia. 
In  the  first  case  in  which  he  tried  this  remedy 
he  was  somewhat  difiident,  and  he  had  ten 
cases  in  which  a  combined  treatment  of  ipecac 
and  aconite  was  used.  However,  he  soon  dis- 
continued the  ipecac  entirely,  finding  there 
was  no  occasion  for  its  use. 

Dr.  Owen  gives  one  minim  every  quarter 
of  an  hour  for  the  first  two  hours,  and  a  minim 
every  subsequent  hour,  or  thirty  minims  in 
twenty-four  hours;  this  method  he  finds  to  be' 
followed  by  the  best  results,  inasmuch  as  the 
action  of  the  medicine  is  more  rapidly  estab- 
lished, and  an  effect  on  the  disease  was  more 
quickly  produced  than  by  other  methods.— 
Medical  News. 


Dr.  Koch  in  one  of  the  demonstrations  ac- 
companying a  discourse  to  the  Physiological 
Society  of  Vienna,  fully  showed  that  miliary 
tuberculosis  is  a  bacteria-disease. 

1.  By  a  definite  method  of  colouring  with 
methyl  violet,  and  then  vesuvin  he  could 
regularly  discern  the  very  characteristic  and 
motionless  projections  of  the  bacillus  distinctly 
on  the  stage. 

2.  It  occurred  to  Koch  to  rear  this  bacillus 
out  of  the  animal  body  and  free  from  all  ex- 
traneous animal  matter,   from  a  specially  pre- 


pared blood  serum — gelatine.  The  bacillus 
grew  very  slowly,  throve  only  at  ii  t(iii|)uiature 
of  30  to  42  C,  and  was  substantially  changed 
from  the  distinctly  pathological  bacillus  to  the 
coccus. 

3.  With  these,  outside  of  the  organism,  for  a 
period  of  200  days,  from  glass  to  glass,  there 
was  obtained  a  cultivated  i);icillus,  in  a  constant 
and  characteristic  way,  siniiiiar  to  those  fouiid 
in  tubeicle. 

4,  When  this  crop,  raised  from  the  coccus, 
was  injected  into  the  blood  of  an  animal,  ficute 
tuberculosis  was  produced  in  a  short  time. 

«  *♦■  • 

Minimum  Doses  of  Iodide  of  Potassium  in 
Frontal  Headaches. — Dr.  Haley  draws  at- 
tention to  the  powerful  anti-cephalalgic  proper- 
ties of  this  drug  when  used  in  small  doses. 
As  a  rule,  a  heavy,  dull  headache  situated  over 
the  brows,  and  accompanied  by  langour,  chilli- 
ness, and  a  feeling  of  general  discomfort,  with 
distaste  for  food  which  sometimes  approaches 
to  nausea,  can  be  entirely  removed  in  about 
ten  minutes  by  a  two-grain  dose  of  iodide  of 
potassium  dissolved  in  about  half  a  wineglass 
ful  of  water,  this  being  quietly  sipped  so  that 
the  whole  quantity  is  consumed  in  about  ten 
minutes.  This  class  of  headache  seems  to 
have  no  particular  or  definite  cause,  belonging 
apparently  to  the  class  of  sympathetic  head- 
aches. In  many  cases  the  effect  of  these  small 
doses  is  simply  wonderful,  and  their  great  ad- 
vantage is  the  rapidity  with  which  they  act. — 
Australian  Medical  Journal. 

A  bill  has  been  introduced  into  the  New 
York  Assembly,  ordering  all  persons  selling 
poisons  of  any  nature  to  put  up  the  same  in  a 
corrugated  bottle  or  box,  with  a  printed  label 
giving  the  antidote  in  English  and  German. 
In  case  of  failure  to  comply,  the  wholesale  or 
retail  dealer  is  declared  guilty  of  a  mis- 
demeanor.— American  Medical  Weekly. 
.  *  ♦  ■  • 

Mental  Status  of  Guiteau. — Dr.  W.  A. 
F.  Browne,  Royal  Commissioner  in  Lunacy 
for  Scotland,  {Journal  of  Psychological  Medi- 
cine, Volume  VII i,  Tait  I.)  after  a  careful 
analysis  of  the  expert  ;ind  other  testimony 
given  in  the  Guiteau  case  comes  to  the  con- 
clusion that  Guiteau  was  insane. — Chicago  Med- 
ical Review. 


OF  MEDICAL  SCIENCE. 


269 


3nv^m. 


JUXTA-EPIPHYSEAL  SPRAIN,  ITS  IM- 
MEDIATE AND  REMOTE  CONSE- 
QUENCES IN  REGARD  TO  INFLAM- 
MATION OF  THE  BONES. 

BY    OLLIER. 

In  his  work  the  author  'gives  extensive  con- 
clusions which  suffice  to  convey  a  just  idea  of"  it. 

L  Juxta-epiphyseal  sprain  is  the  totality  of 
the  lesions  produced  in  the  juxta-epiphyseal  re- 
gions of  the  diaphysis  of  the  long  bones  by 
forced  movements  of  the  articulations. 

2.  In  young  children,  especially  under  the 
age  of  3  years,  forced  movements  of  the  ar- 
ticulations do  not  produce  appreciable  articular 
disorders  ;  they  give  rise  chiefly  to  disturbances 
in  the  osseous  tissue  of  the  juxta-epiphyseal 
regions. 

3.  These  disorders  of  the  osseous  tissue  con- 
sist, sometimes,  in  the  first  degree  of  diaphyseal 
separation,  sometimes  in  an  incomplete  fracture 
of  the  juxta-epiphyseal  region.  They  are  the 
more  easily  produced  according  as  the  consis- 
tence of  the  bone  has  been  more  altered,  either 
by  rachitism  or  by  any  other  acute  or  chronic 
afl'ection,  which  may  have  disturbed  the  nutri- 
tion of  the  osseous  system. 

4.  As  these  lesions  occur  in  the  depth  of  the 
bone  beneath  the  periosteum,  they  often  pass 
unperceived,  not  only  by  the  clinician  whose 
eyes  are  solely  preoccupied  by  the  search  for  ar- 
ticular lesions,  but  also  by  the  experimentalists, 
who  have  not  recognised  them,  although  they 
must  necessarily  have  produced  them  in  all 
their  experiments  upon  the  so-called  separation 
of  the  epiphyses. 

5.  These  disorders  consist  in  the  following 
lesions :  crushing  depression,  trabecular  frac- 
tures of  the  spongy  tissue,  inflexion,  torsion, 
infraction  of  the  thin  compact  peripheral 
layer,  and  as  a  consequence  of  these  ruptures, ex- 
pression of  ^  the  medullary  juice,  blood  effusions 
into  the  spongy  tissue,  and  beneath  the  more  or 
less  separated  periosteum. 

6.  If  the  effort  continues,  permanent  depres- 
sion of  the  compact  peripheral  layer  on  the  side 
of  flexion,  (juxta-epiphyseal  notch)  fracture  by 
dragging-tension  and  tearing  of  the  periosteum 
on  the  side  of  extension.     This  is  the  moment 


at  which  are  prepared  and  soon  effected  fracture 
or  separation  of  the  diaphysis  and  its  luxation 
without  the  periosteal  sheath. 

7.  Juxta-epiphyseal  sprain  is  generally  with- 
out gravity,  and  is  reduced  to  a  painful  toppor 
which  soon  disappears  of  itself.  But  if  the 
child  is  not  taken  care  of,  and  if  it  is  scrofulous 
or  hereditarily  predisposed  to  tubercle,  the 
juxta-epiphyseal  sprain  will  be  the  frequent 
origin  of  osteomyelites,  early  or  late,  which  are 
explained  by  the  depression  and  the  trabecular 
fractures  of  the  spongy  tissue.  All  the  forms 
of  osteomyelitis  may  be  consequent  upon  the 
lesions  of  juxta-epiphyseal  sprain. 

8.  Juxta-epiphyseal  sprain  gives  rise  to  a 
tumefaction  more  or  less  painful,  but  very  clear, 
of  the  juxta-epiphyseal  region,  the  neighbouring 
articulations  remaining  free.  This  is  the  char, 
acteristic  symptom  of  this  lesion.  It  is  due  to 
the  tumefaction  of  the  separated  periosteum, 
and  the  hyperplasia  of  its  osteogenic  layer. 

9.  What  has  been  called  painful  forced  prona- 
tion, painful  torpor  of  young  children  is  ex- 
plained by  juxta-epiphyseal  sprain. 

10.  To  prevent  the  dangers  of  juxta-epiphy- 
seal sprain,  there  is  only  immobilisation  of  the 
limbs  for  a  sufficient  time.  It  is  necessary 
then  to  carefully  examine  in  children  limbs 
which  have  been  the  seat  of  a  forced  movement, 
or  which  have  suffered  in  a  fall,  and  if  we  find 
a  juxta-epiphyseal  swelling,  painful  or  not,  to 
care  for  these  children  until  the  bone  has  re- 
gained its  normal  volume. — {Revue  de  Chir.) — 
X'  Union  Medical. 


Orchitis. — I  know  of  no  remedy  that  will 
allay  the  pain,  and  subdue  the  inflammation 
of  a  swelled  testicle  so  effectually,  as  a  tobacco 
and  flaxseed  meal  poultice.  The  application 
was  usid  by  some  New  York  surgeons  long 
before  it  became  much  known,  and  Van  Buren 
and  Keyes  have  probably  done  more  than  any 
others  to  spread  the  knowledge  of  its  use.  A 
hot  flaxseed  meal  poultice  to  which  has  been 
added  previously,  about  half  a  paper  of  fine 
cut  chewing  tobacco,  should  be  applied  fresh 
two  or  three  times  a  day,  until  the  swelling  and 
pain  subside.  A  piece  of  oil  silk  should  be 
placed  outside  the  poultice  to  prevent  evapora- 
tion. This  poultice  gives  relief  quickly,  and  in 
the  course  of  a  few  days,  the  swelling  is  so 
reduce  1  that  an  ordinary  suspensory  bandage 
may  be  worn  with  comfort. — Phila.  Medical 
Tiines. 


270 


CANADIAN  JOURNAL 


SUBBOTIN  ON  TREATMENT  OF  HE- 
MORRHOIDS BY  FORCIBLE  DILA- 
TATION OF  THE  ANUS. 

V.  IDELSON,  M.D. 

Having  referred  to  the  dangers  accompany- 
ing the  usual  methods  of  radical  treatment  of 
hjemorrhoids,  i.e.,  excision,  ligature,  and  cau- 
terisation. Professor  Subbotin  [Mejdunarod- 
naia  Clinica,  No.  1,  1882)  advocates  a  fourth 
method,  which  is  alleged  to  be  entirely  free 
of  such  dangers  as  subsequent  pyaemia,  stric- 
ture of  the  anus,  secondary  hemorrhage, 
general  peritonitis,  etc.  This  operation  is  forci- 
ble dilation  of  the  anus  and  lower  part  of  the 
rectum,  recommended,  about  thirty  years  ago, 
by  Maisonneuve,  and  after  many  years  of 
oblivion,  in  1876-77,  again  introduced  into 
practice  by  Verneuil  and  Fontan,  and  later  by 
Guyon,  Trelat,  and  other  French  surgeons. 
The  author,  from  his  own  experience,  draws 
attention  to  the  simplicity,  safety,  rapidity  of 
curative  action,  and  efficiency  of  this  method, 
which  is  described  by  him  as  follows  :  On  the 
day  before  the  operation  the  bowels  are 
thoroughly  opened  by  a  purgative  ;  and  im- 
mediately before  the  dilatation,  the  rectum  is 
washed  out  by  an  enema.  The  patient  being 
brought  under  the  influence  of  chloroform,  and 
placed  on  his  -left  side,  with  his  thighs  fully 
flexed,  the  operator  stands  behind  the  patient 
and  introduces  a  bivalved  Recamier's  anal 
speculum,  then  he  gradually  and  cautiously 
opens  the  speculum  (introduced  down  to  its 
handle) ;  and,  when  all  the  rugae  of  the  ano- 
rectal mucous  membrane  have  been  efikced  by 
stretching,  he  leaves  the  instrument  opened  to 
its  widest  extent  in  situ  for  two  or  three 
minutes,  and  then  removes  it.  With  this  ac- 
tion the  treatment  comes  to  an  end,  no  after- 
treatment  being  required.  The  operation  lasts 
about  six  to  eight  minutes.  The  immediate 
efiects  of  the  dilatation  consist :  1.  in  a  paretic 
state  of  both  rectal  sphincters,  which  exists 
three  or  four  days,  and  then  is  followed  by 
normal  contraction  of  the  parts  ;  and  2,  in  com- 
plete relaxation  or  disappearance  of  the  haemorr- 
hoid  varices.  Small  piles  usually  disappear  at 
once,  never  to  return  ;  large  ones  remain  visible 
for  some  time  after  the  operation  as  soft,  lax. 


and  empty  capsules.  These  are  gradually 
dimiuished,  and,  as  a  rule,  Anally  disappear,  or 
remain  in  the  shape  of  simple  polypi,  causing 
no  discomfort  to  the  patient.  According  to 
the  author,  the  action  of  dilatation  in  the 
treatment  of  haemorrhoids  is  two-fold.  First, 
by  relaxing  the  sphincters,  it  removes  the 
cause  cf  stagnation  of  the  blood  in  the  begin- 
nings of  the  haemorrhoidal  veins;  and,  secondly, 
it  expels  the  contents  of  the  varices  and  com- 
presses their  walls  in  such  a  way  as  to  cause 
their  adhesion  and  obliteration  of  the  cavity. 
Professor  Subbotin  points  out  only  two  contra- 
indications to  forcible  dilatation.  They  are, 
suppuration  and  incipient  gangrene  of  the  piles. 
In  cases  of  highly  tense  and  irreducible  haemorr- 
hoids, he  advises  that  the  operation  should  be 
done  in  two  stages  :  first,  dilating  by  means  of 
the  fingers  alone,  and,  some  days  later,  proceed- 
ing w  ith  instrumental  dilatation, — London 
Medical  Record. 


THE   REDUCTION   OF   OLD   HERNIA. 

Ordinarily  an  old  and  large  hernia  is  left 
pretty  much  to  itself.  Palliative  measures 
alone  are  attempted.  Yet  the  positive  and 
continuous  inconveniences  remain,  sufficient  in 
many  cases  to  render  life  a  burden,  and  should 
be  a  constant  incentive  to  renewed  efforts. 
M.  Thiry,  in  the  Bulletin  de  V  Acadkmie 
Royale  de  Belgique,  has  lately  shown  us  what 
may  be  justly  called  a  new  method  of  dealing 
with  such  tumours,  by  frequently  repeated 
attempts  at  the  taxis  with  compression  during 
the  intervals. 

The  patient  was  a  man  of  forty-two,  whose 
hernia  measured  sixty-seven  centimetres  in 
circumference.  The  intestines  had  " jjerdu 
droit  de  domicile  "  in  the  abdomen  and  were 
all  in  the  scrotum,  and  produced  a  considerable 
dysuria.  Undismayed  by  the  size  and  age  of 
the  hernia,  M.  Thiry  repeated  the  taxis  twenty- 
four  times,  at  unequal  intervals  extending  over 
nearly  three  months.  At  each  sitting  more  or 
less  of  the  liernia  was  reduced,  and,  once 
reduced,  was  retained  in  place  by  an  elastic 
bandage.  After  complete  reduction,  a  truss 
with  a  very  convex  pad  penetrating  into  the 
ring  was  applied.     At  the  end  of  some  months. 


OF  MEDICAL  SCIENCE. 


271 


the  reduction  was  still  eflfectual,  the  abdomen 
had  resumed  its  usual  rotundity,  and  urination 
was  readily  accomplished.  Life  had  again  be- 
come desirable. 

We  commend  so  happy  a  success  to  our 
readers.  Old  herniae  are  so  frequent  and  so 
annoying  that  he  who  opens  a  new  path  to 
theii-  sucessful  treatment  confers  a  great  boon 
on  multitudes  of  suflferera. 

Of  course,  in  very  many  cases  the  adhesions 
aresuch  as  to  forbid  the  hope  of  success.  But 
no  such  hernia  should  be  abandoned  without 
at  least  patient  and  repeated  trials. — Medical 
News. 


TREATMENT  OF  STRUMOUS  GLANDS. 
The  treatment  of  chronic  caseating  strumous 
glands  has  undoubtedly  been  improved  in  quite 
recent  times.     In  the  earlier  stages  the  external 
application  of  iodoform,  in  the  form  of  its  coL 
lodion,  is   frequently   of  marked  service,  and 
when  suppuration  has  taken  place  the  thorough 
local  application  of  powdered  iodoform,  and  the 
enucleation  of  the  glands  are  of  great  value  in 
cutting  short  the  affection  and  producing  a  quick 
recovery.    In  a  paper  in  the  Central,  f.  Chirurg., 
Dr.   Von    Lesser  'points   out   that  the  disease 
in  the  glands  often  assumes  the  form  of  small 
caseous  foci,  which  may  become  encapsuled  and 
possibly  calcareous,  but  are  more  likely  to  lead 
to  suppuration,  during  which  they  are  extruded, 
or  to  general  tubercular  infection.     In  view  of 
these  events  he  has,  while  the  glands  are  still 
only  indurated,  attempted  to   enucleate  these 
caseating  portions  of  the  glands.     His  operation 
is  thus  performed.     Fixing  the  gland  and  push- 
ing it  forward   under  the  skin  with  the  finger 
and  thumb  of  the  left  hand,  he  makes  a  small 
puncture  through  the  skin  and  into  the  gland 
with  a  narrow  knife.     Through  this  wound  he 
passes  a  small  sharp  spoon  and  scrapes  the  in- 
terior of  the  gland.     The  soft  cheesey  portions 
readily  yield  and  come  away,  while  the  more 
healthy  parts  of  the  gland  prove  more  resistant. 
If  several  glands  lying  close  together  are  en- 
larged, he  operates  on  them  all,  or  on  several 
through  one  skin  wound,  the  spoon  being  push- 
ed into  one  after  another.     By  this  means  the 
disease  is  cut  short,  ulterior  dangers  are  avoided, 
and  unsightly  scars  prevented.     Lesser  recom- 


mends that  the  operation  should  be  done  with 
strict  antiseptic  precautions,  and  that  care 
should  be  taken  not  to  wound  any  large  vessel, 
nor  to  leave  behind  in  the  wound  any  of  the 
cheesey  debris. — London  Lancet. 


Experiments  with  Catgut  Ligatures  on 
Animals. — MM.  Gross  and  Rohmer  [Revue  de 
Ghir.,  1881,  p.  961)  having  made  numerous 
experiments  oi  animals,  arrive  at  the  following 
conclusions  :  1.  The  immediate  effect  of  cat- 
gut ligature  in  the  continuity  of  an  artery  is 
the  same  as  that  of  an  ordinary  ligature.  The 
outer  coat  resists  the  constriction  and  is  rein- 
forced by  the  new  tissue  formed  under  the 
influence  of  the  irritation  produced  by  the 
ligature.  The  vessel  is  never  divided.  The 
fear  of  secondary  haemorrhage  is,  therefore, 
abolished,  and  the  ligature  of  the  arteries  in 
their  continuity  has  become  less  serious  than 
heretofore.  2.  An  ordinary  double  knot  only 
produced  temporary  obliteration  of  the  artery  ; 
the  ligature  becomes  prematurely  loose,  perhaps, 
before  any  clot  is  formed  ;  or  the  thrombus,  if 
formed,  disappears,  the  ruptured  coats  heal, 
and  the  calibre  of  the  vessel  is  restored  in 
eight  or  nine  days.  Before  the  fifteenth  day, 
the  obliteration  cannot  be  considered  as  final. 
3.  In  order  to  obtain  final  closure  of  the  vessel, 
the  ligature  must  be  secured  by  a  surgical  knot 
upon  which  is  added  a  simple  -knot,  as  recom- 
mended by  G.  and  T.  Boeckel,  of  Strasburg. — 
Birmingham  Medical  Review. 

■  m*»  ■ 

Absorption  of  Sequestra. — M.  Yrignal  has 
lately  made  a  series  of  experiments  on  this 
subject.  He  has  determined  that  a  sequestrum 
covered  with  pus  will  not  be  absorbed,  whilst 
one  enveloped  with  granulations  will  be.  A 
fragment  of  bone  (bone  peg)  being  driven  into 
the  tibia  of  a  rabbit  wa^  almost  entirely  ab- 
sorbed.— Gaz.  des  Hop. — St.  Louis  Med.  and 
Surg.  Journal — Cincinnati  Lancet  and  Clinic, 
« ^♦^ « 

Treatment  of  Eczema  with  Animal  Char- 
coal.— Onocool  Chunder  Chatterjee  claims  to 
have  found  a  specific  for  eczema  in  freshly-pre- 
pared animal  charcoal  made  into  an  ointment 
and  applied  to  the  affected  part.  He  finds  it 
particularly  efiicacious  in  vesicular  eczema  con- 
fined to  the  extremities. — Indian  Med.  Gazette, 


272 


CANADIAN  JOURNAL 


^litUvif^rji. 


VIENNA  GENERAL  HOSPITAL. 

(Service  of  Peof.  Spaeth.  ) 

VIABILITY  OF  PREMATURE  CHILDREN. 

A  pair  of  male  twins  was  recently  brought 
into  the  lecture-room  of  Prof.  Spaeth,  and 
formed  the  text  of  some  remarks  upon  this 
subject.  One  of  the  children  presented  several 
malformations,  such  as  hydrocephalus,  harelip, 
cleft  palate,  club  feet,  umbilical  hernia,  etc. 

The  other  was  born  alive,  normally  formed, 
and  weighed  900  grammes.  If  the  weight  of  a 
fully-developed,  new-born  child  is  taken  at 
3,000  grammes,  1,500  grammes  will  be  the 
weight  of  a  child  at  the  end  of  the  seventh 
lunar  month.  A  weight  of  900  grammes  cor- 
responds to  a  foetus  in  the  second  half  of  the 
sixth  lunar  month,  and,  according  to  the 
generally  received  opinion,  the  child  was  not 
viable,  since  the  end  cf  the  seventh  lunar 
month  is  the  accepted  time  of  viability. 

Prof.  Spaeth,  however,  supported  by  his  rich 
experience,  affirmed  that  children  even  in  the 
sixth  lunar  month  could  be  kept  alive,  if  special 
care  was  taken  in  their  treatment.  The  slight 
amount  of  bodily  heat  which  these  children 
produce  renders  it  necessary,  in  the  first  place, 
to  guard  against  the  dissipation  of  that  agent. 
For  this  purpose,  careful  wrapping  in  cotton- 
wool is  excellent. 

The  delicacy  of  the  digestive  organs  must  be 
noted,  and  only  such  milk  selected  for  nutri- 
ment as  contains  a  small  amount  of  casein,  the 
constituent  of  milk  most  difficult  of  digestion. 
Experience  teaches  that  the  longer  a  nurse 
suckles,  so  much  richer  in  casein  does  her  milk 
become. 

It  is,  therefore,  necessary  to  select  for  a  wet- 
nurse  a  young  woman  who  has  been  very 
recently  delivered.  Another  requisite  is  that 
the  wet-nurse  must  have  long  nipples ;  since 
the  child  itself  is  too  weak  to  suck  and  to 
swallow,  the  nipple  must  extend  deep  into  the 
mouth,  so  that  the  milk  runs,  so  to  speak, 
directly  into  the  stomach. 

That  it  is  possible  to  raise  a  child  so  poorly 
developed.  Prof.  Spaeth  proves  by  the  relation 
of  a  case  in  his  own  private  practice.  The 
child    was   bom    in    the   sixth    month.       The 


parents  were  wealthy  and  every  detail  of  the 
costly  experiment  was  scrupulou.sly  carried  out. 
The  child,  a  boy,  is  now  five  years  old,  in 
perfect  health  and  bodily  vigour.  Indeed,  in 
this  x'espect,  he  surpasses  his  brothers  and 
sisters,  who  came  into  the  world  at  the  end  of 
the  usual  period.  Moreover,  that  the  mortality 
among  premature  children  is  very  great  is 
easily  comprehensible  when  the  great  mortality 
of  children,  generally,  during  the  first  year  of 
life,  is  taken  into  consideration. — Medical 
News. 

To  the  Editor  of  the  Canadian  Journal  of  Medical  Scikncr. 

CLINICAL  EXAMINATIONS. 

Sir, — In  reading  your  report  of  the  pro- 
ceedings of  the  Medical  Council  at  its  last 
session,  I  observe  that  you  have  published  one 
of  the  motions  as  it  appeared  in  the  columns  of 
the  daily  press.  I  refer  to  that  one  in  reference 
to  "  clinical  lectures  "  at  the  Toronto  General 
Hospital.  If  you  had  substituted  the  word 
examinations  for  "  lectures "  you  would  have 
been  exactly  right. 

The  Council  has  no  direct  power  to  establish 
a  course  of  clinical  lectures  at  the  Hospital ; 
but  by  carrying  into  effect  the  motion  foi'  ex- 
aminations it  will  in  a  very  great  measure 
assist  the  Hospital  authorities,  and  those 
medical  gentlemen  engaged  in  clinical  teaching 
there,  to  secure  a  thorough  course  of  clinical 
lectures. 

At  the  suggestion  of  some  of  our  most  active 
teachers,  and  with  this  object  especially  in  view 
I  was  led  to  bring  in  the  resolution.  It  is  not  a 
matter  of  disappointment  that  immediate  action 
was  not  taken  by  the  Council,  for  this  is  a  subject 
requiring  more  than  passing  consideration- 
The  members  generally  were  strongly  in  favour 
of  the  scheme  and  deferred  it  until  next  session 
iu  order  to  enquire  more  closely  into  the 
practicablity;  and  the  readiness  with  which  the 
motion  was  accepted  leads  me  to  believe  that 
suggestions  from  members  of  the  profession  as 
to  how  these  examinations  may  be  held  will 
receive  attentive  consideration. 
Yours  truly, 

J.  H.  Burns. 

Toronto,  July,  1882. 


OF  MEDICAL  SCIENCE. 


273 


To  the  Editor  of  the  Canadiak  Journal  of  Mbdical  Sctbnce. 

Dear  Sir, — Leipsic,  a  city  of  about  225,000 
inhabitants,  is  celebrated,  as  a  fellow-traveller 
expressed  it,  in  these  particulars  :  as  a  place 
of  business,  as  a  place  for  the  study  of  science, 
and  on  account  of  its  presenting  great  facilities 
for  the  cultivation  of  art,  especially  music, 
the  Conservatory  being  the  most  renowned 
in  Europe.  To  the  medical  world  it  is  of 
special  importance  on  account  of  the  patho- 
logical laboratory.  The  latter  is  a  large  build- 
ing which  affords  every  facility  for  making 
post-mortem  examinations,  and  for  micro- 
scopical work.  In  the  histological  room  there 
is  an  immense  amount  of  material  arranged 
and  classified,  so  that  the  student  can  easily 
find  what  he  requires  for  section.  Cohnheim's 
microtome  is  very  much  used  here.  It  is 
especially  good  for  cutting  fresh  specimens,  as 
they  can  be  easily  frozen,  and  beautiful  sections 
made.  Medicine  is  well  taught  by  Professor 
Wagner,  who  is  now,  perhaps,  the  best  clinical 
lecturer  in  Germany.  He  was  for  years  Pro- 
fessor of  Pathology,  a  course  which  has  emi- 
nently fitted  him  for  the  position  he  n<»w 
occupies.  One  is  struck  with  the  very  thorough 
manner  in  'which  post-mortems  are  made.  They 
are  done  according  to  a  certain  system,  and 
every  organ  is  thoroughly  examined. 

I  shall,  however,  leave  Leipsic  and  hurry  on 
to  Vienna.  The  latter  city  presents  many 
features  peculiar  to  itself  as  a  place  for  medical 
study.  The  vast  amount  of  material  afforded 
by  the  hospital,  and  the  lai'ge  staff  of  teachers, 
render  it  an  easy  matter  for  a  medical  practi- 
tioner", who  has  only  a  few  weeks  at  his  dis- 
posal, to  spend  his  whole  time  in  the  study  of 
one  or  two  subjects.  One  can,  for  instance, 
spend  ten  hours  a  day  at  gross  pathology  and 
pathological  histology,  or  at  dermatology,  or 
surgery,  &c. 

In  gross  pathology  I  might  give  a  short  list 
of  some  of  the  rare  specimens  presented  during 
the  last  three  weeks.  1.  A.  case  of  peritonitis 
produced  by  collection  of  hardened  fceces  in 
the  form  of  nodules  in  diverticula  of  the  inte^- 
':ine.  These,  by  their  presence,  excited  inflam- 
mation and  ulceration.  2.  A  heart  with 
stenosis  of  both  mitral  and  tricuspid  valves. 
3.  Cholesteatoma   at   the   base   of   the   brain. 


which,  although  of  considerable  size,  did  not 
produce  any  marked  symptoms  during  life.  4, 
A  dermoid  cyst  of  the  ovary,  somewhat  larger 
than  a  child's  head,  the  walls  of  which  had 
undergone  carcinomatous  change  and  ulcerated 
through  into  the  duodenum.  The  interior  of 
the  cyst  was  partly  filled  with  matter  which 
had  passed  out  of  the  intestine,  and  partly  with 
hair  and  other  epidermic  growths.  6.  Uterus 
unicornuus  with  narrowing  of  the  internal  os. 
7.  A  case  of  suppurative  hepatitis,  produced  by 
the  pressure  of  an  ascaris  lumbricoides  in  the 
common  bile  duct.  The  latter  had  been  dis- 
tended by  the  passage  of  gall  stones,  and  the 
worm  had  found  its  way  into  the  liver  from  the 
duodenum.  The  great  advantage  they  have 
here  in  teaching  pathological  anatomy  is  the 
way  in  which  they  cin  often  group  specimens. 
For  instance,  they  presented  on  the  same  day 
three  different  forms  of  ovarian  tumours,  and 
on  another  three  different  kinds  of  ulceration 
of  the  bowels. 

In  the  medical  department,  a  case  of 
hydronephrosis  in  a  floating  kidney  was  shown 
and  lectured  on  by  Dr.  Bamberger.  In  the 
skin  clinic  there  were  no  less  than  three  cases 
of  scleroderma  at  one  time.  This  is  remarkable 
considering  the  rarity  of  the  disease.  The^ 
more  one  sees  of  this  obscure  affection,  the 
more  one  is  convinced  that  we  know  little  of 
its  true  pathology.  The  cases  here  presented 
very  remarkable  pigmentary  changes.  A  case 
of  multiple  sarcoma  of  the  skin,  of  the  fungoid 
character,  was  also  shown.  Primary  disease  of 
the  skin  of  this  form  is  very  rare,  and  most  of 
the  cases  have  been  of  the  pigmentary  or 
melanotic  kind.  Only  four  or  five  cases  of  the 
fungoid  variety  have  yet  been  reported.  A 
case  of  pityriasis  rubra  has  also  been  under 
observation,  which  presented,  on  the  lower  ex- 
tremities, small  gangrenous  patches. 

One  of  the  most  interesting  features  of  the 
Vienna  Hospital  is  Prof.  Billroth's  clinics.  He 
operates  every  morning,  usually,  from  two  to 
three  houi-s,  and  during  the  time  that  the 
patients  are  being  anaesthetized  gives  short 
lectures  on  the  abundant  material  always  at 
hand.  He  has  ten  assistants,  each  of  whom 
appears  to  have  his  own  special  duty,  so  that, 
although    they   are   always   busy,  there  is  no 


274 


CANADIAN  JOURNAL 


confusion.  Oj)eration8  of  great  magnitude 
seem  to  be  performed  with  the  same  coolness 
as  the  removal  ot  trifling  tumours.  Opening 
tlio  peritoneal  cavity  is  a  matter  of  frequent 
occurrence.  The  spray  is  not  used,  but  the 
part«  to  be  operated  on  are  first  thoroughly 
washed  with  a  solution  of  carbolic  acid,  and 
the  instiuments  are  placed  in  trays  containing 
the  same  solution.  A  modification  of  the 
antiseptic  dressing  is  used. 

The  great  event  of  the  past  week  was  the 
address  and  torch-light  procession  given  in 
lion^ur  of  Billroth.  During  the  past  month 
the  hitter  was  offered  Langenbeck's  position  in 
Berlin,  and  very  great  efforts  were  made  by 
the  Berlin  University  to  induce  the  celebrated 
Vienna  surgeon  to  return  to  his  native  land. 
Billroth,  however,  declined,  preferring  to  re- 
main here  where  his  greatest  triumphs  have 
been  achieved.  In  recognition  of  his  abilities 
and  high  standing  as  a  surgeon,  and  of  the  fact 
of  his  refusing  so  tempting  an  offer  as  the 
Berliners  had  made,  the  students  determined  to 
present  an  address  and  give  him  a  torch-light 
procession.  The  programme  was  carried  out 
last  Thursday.  The  address  was  presented  at 
noon  in  the  aula  of  the  old  University,  and 
the  torch-light  procession  took  pl>jce  in  the 
evening.  The  latter  was  in  every  way  a  most 
brilliant  affair.  The  streets  were  lined  by  tens 
of  thousands  of  people,  and  the  procession  was 
at  least  a  mile  long.  It  was  formed  on  the 
opposite  side  of  the  city,  and  marched  through 
to  Dr.  Billroth's  residence.  After  a  serenade 
by  the  Students'  Choral  Society,  the  Dr.  made 
a  short  address.  While  witnessting  the  pro- 
cession one  nat'irally  wondered  if  it  would 
ever  happen  on  our  side  of  the  Atlantic,  that  a 
city  of  nearly  a  million  inhabitants  should  be 
moved  to  its  very  centre,  as  Vienna  was,  to  do 
honour  to  a  man  pui-ely  for  his  scientific  work. 
Ic  is  not  difi&cult  to  get  up  such  an  excitement 
for  a  politician  or  a  champion  oarsmm,  hat  I 
am  afraid  it  will  be  a  long  time  before  so  much 
spontaneous  enthusiasm  is  shown  in  honour  of 
a  physician  or  surgeon,  no  matter  how  great 
his  attainments  in  tho.se  departments. 

According  to  the  public  press,  this  was  the 
most  brilliant  affair  of  the  kind  since  the  time 
of  Rjkpitansky.  J.  E.  G. 


I 


THE  CANADIAN 

(iirniti  of  4  tiliriil  MtMt, 

A  Monthly  Journal  of  Medical  Science,  Criticism, 
and  News 


To  Correspondents. —  IVe  shall  be  glad  to  re- 
ceive fi'om  our  friends  everywhere,  current  meaical 
news  oj  general  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
fotwardins;  reports  of  the  proceedings  of  their 
Associations 


TORONTO,  AUGUST,   1882. 


HOSPITAL    OUT-PATIENT    DEPART- 
MENTS. 

The  out-patient  departments  of  general 
hospitals,  their  iise  and  abuse,  have  long 
formed  the  theme  of  interesting  and  animated 
discussions,  both  lay  and  professional.  The  nn- 
cpiestionable  question  of  their  abuse  is  not 
however  our  present  topic,  ragard  being  merely 
had  to  the  best  mode  of  use,  and  the  highest 
proficiency  of  our  own  out-door  department. 
And  first  with  regard  to  the  mode  of  use.  As  at 
present  conducted,  during  the  six  months  of  the 
session  of  the  schools,  the  schoolmen  on  the 
staff  are  told  off  to  take  day  about  in  rotation  ; 
and  during  the  other  six  months  in  the  year, 
the  non-schoolmen  discharge  the  duty  in  like 
manner.  There  is,  in  our  opinion,  great  room 
for  doubt  if  the  oub-door  department  can  be  as 
thoi-onghly  and  profitably  worked  by  the  in-door 
staff,  as  it  could  be  by  a  separate  and  less  busy 
body.  The  fact  cannot  be  gainsaid  that  the 
labour  of  seeing  out-patients  is  both  time  con- 
suming and  arduous,  and  it  is  scarcely  to  be 
exp^>cted  that  those  whose  available  time  is 
pretty  fully  occupied  with  in-door  cases,  will 
be  likely  to  manifest  that  same  zeal  and  atten- 
tion in  out-patient  work,  which  might  reason- 
al)ly  be  looked  for  from  an  active,  intelligent, 
and  ambitious  assist \nt  stiff.  We  should, 
therefore,  rnjoice  to  see  a  staff  of  assistant 
physicians  appointed  for  out-patient  duty.  Six 
might  be  elected  to  serve  one  day  a  week  each, 
or  three  appointed  to  go  on  duty  twice  a  week. 
This  might  n^adily  be  accomplished  by  amal- 
gamation with  the  Toronto  Dispeysary,  or  by  a 
judicious  selection  from  the  many  accomplished 


OF  MEDICAL  SCIENCE. 


275 


and  highly-qualified  younger  practitioners  in 
the  city.  We  are  aware  that  objections  have 
been  expressed  to  the  multiplication  of  the 
numl)er  of  practitioners  already  connected  with 
the  hospital,  but  we  certainly  must  confess  that 
we  do  not  understand  the  objections,  and,  there- 
fore, cannot  sympathize  therewith.  The  whole 
field,  —in-door  and  out-door,— constitutes  i  rich 
mine  of  information,  a  wide  sphere  for  charity, 
utility,  and  humanity,  yielding  greater  results 
as  worked  by  the  greater  number. 

Apart  from  the  consideration  of  having  the 
work  more  carefully  and,  therefore,  better  done, 
teachers  should  be  anxious  for  the  full  develop- 
ment of  the  out-patient  department,  as  capable 
of  securing  mor«  material  for  clinical  lectures, 
and  of  replenLshing  the  wards  with  instructive 
cases.  Properly  conducted,  too,  it  would  serve 
to  relieve  the  wards  of  many  unsuitable  cases 
without  entailing  an  uncharitable  neglect  of 
minor,  though  distressing,  ailments,  in  cases 
which  require  supervision  and  occasional  atten- 
tion, though  not  constant  treatment.  Facilities 
for  gynaecological  out-patient  practice  are  greatly 
wanting  in  this  city,  and  this  lacuna  in  our 
eleemosynary  institutions  the  out-door  depart- 
ment of  our  hospital  might  properly  be  made  to 
fill,  two  days  a  week  at  difi'erent  hours  from 
the  ordinary  out-patient  visits  being  set  apart 
therefor.  The  out-patients'  department  should 
be  a  grand  school  for  the  practitioners  engaged 
therein,  as  well  as  for  the  students,  and  both 
directly  and  indirectly  of  immense  advantage 
to  the  public.  It  is  with  the  hope  that  some- 
thing of  importance  may  yet  be  accomplished  in 
this  direction  that  we  have  ventured,  at  this 
juncture,  to  direct  attention  to  the  subject. 


OVARIOTOMISTS,      ATTENTION  ! — Dr.      J.       E. 

Janvrin,  of  191  Madison  Avenue,  New  York 
City,  has  been  selecte'  to  prepare  the  chapter 
on  the  History  and  St^atistics  of  Ovariotomy  in 
the  System  of  Gynjecolugy  by  American 
Authors  which  is  to  appear  at  the  end  of  the 
year.  He  is  desirous  that  all  who  wish  their 
cases  ])ublished  should  forward  to  him  before 
the  Ist  Sept.  next  answers  to  a  jjrintf'd  list  of 
questions  which  will  be  forwarded  to  any 
address  on  application. 


CLINICAL  EXAMINATIONS. 

We  have  much  pleisure  in  publishing  in 
this  issue  a  letter  from  Dr.  Burns  with  refer- 
ence to  his  motion  in  the  Medical  Council 
respecting  Clinical  Examinations.  We  have 
often  commented  on  the  great  importance  of 
practical  examinations,  and  have  cheerfully 
given  the  Council  due  credit  for  the  important 
steps  it  has  taken  in  improving  the  character  of 
the  examinations  year  after  year.  It  requires 
a  peculiar  aptitude  to  render  a  man  a  good 
practical  examiner,  and  it  was  somewhat  dis- 
couraging to  see  the  Council,  at  its  last  session, 
leave  one  of  the  best  clinical  examiners  off"  the 
B  )ard,  after  a  term  of  only  two  years.  An 
examiner  is  much  better  fitted  for  his  work  his 
third  year  than  his  first;  why  should  he  be 
dismissed  just  when  his  fitness  has  been 
thoroughly  established,  in  order  to  provide  a 
place  for  a  new,  untried  man  who  may,  as 
sometimes  in  times  past,  prove  to  be  a  disastrous 
failure? 

After  the  appointment  of  a  suitable  Board 
the  most  important  consideration  is  the  adop- 
tion of  a  suitable  system,  which  will  enable  the 
examiners  to  give  the  candidates  an  oppor. 
tunity  to  show  their  practical  knowledge  in  the 
diagnosis  and  treatment  of  disease,  as  well  as 
their  practical  skill  in  note-taking,  bandaging, 
surgical  dressing,  etc.  This  can  only  be  done 
by  taking  the  students  to  the  Hospital,  or  by 
bringing  patients  to  the  Council  Hall  while 
the  examination  is  going  on,  or  by  both  plans. 
We  shall  be  glad  to  give  space  in  our  columns 
to  any  suggestions  from  medical  men  who 
take  an  interest  in  this  very  important  subject. 

NEW  REGISTER. 
As  before  announced,  a  new  Medic il  Regis- 
ter for  Ontario  is  being  prepared,  and  is  ex- 
pected to  be  in  the  printers'  han  Is  in  a  short 
time.  All  who  have  changed  their  place  of 
residence,  or  who  wish  to  register  new  degrees, 
etc.,  should  at  once  communicate  with  the 
registrar,  Dr.  Pyne,  as  requested  by  him  in 
adv.rLisement  which  appears  in  this  issue. 


The  British  M-  dical  Association  will  hold 
its  Jubilee  Meeting  at  Worcester— its  birth- 
place—on  the  8th,  9  th,  10 ch,  and  llth  instant. 


276 


CANADIAN  JOUliNAL 


MEETING  OF  THE  CANADA  MEDICAL 
ASSOCIATION. 

The  members  of  the  Profession  in  Toronto 
are  taking  an  unusaal  interest  in  the  next 
meeting  of  the  Canada  Medical  Association,  to 
be  held  in  this  city  on  the  6tb,  7th,  and  8th  of 
September.  The  Committee  of  Arrangements 
appointed  at  the  Halifax  meeting,  has  made 
large  additions  to  its  numbers,  and  all  are 
uniting  in  the  effort  to  extend  a  cordial  and 
hearty  welcome  to  those  who  come  from  a 
distance. 

Dr.  Daniel  Clark,  Superintendent  of  tlw. 
Toronto  Asylum  for  Insane,  has  kindly  sig- 
nified to  the  Committee  his  intention  of  in- 
viting the  members  of  the  Association  to  a 
luncheon  in  the  Asylum, 

It  has  been  decided  by  the  Committee  that 
the  reception  by  members  of  the  Profession  in 
Toronto  shall  take  the  form  of  a  conversazione 
to  be  held  in  the  Normal  School  buildings, 
which  have  been  kindly  placed  at  their  disposal 
by  the  Government.  We  will  give  further 
particulars  in  our  next  issue. 

From  the  reports  which  have  reached  us 
from  a  distance,  we  have  no  doubt  that  tliero 
will  be  a  large  attendance,  and  we  have  strong 
reasons  to  hope  that  the  meeting  will  be  in 
every  sense  a  most  interesting  one.  The  General 
Secretary,  Dr.  Osier,  of  Montreal,  with  tin; 
assistance  of  the  local  Secretary  for  Ontario,  is 
making  arrangements  with  the  railroad,  and 
steamboat  companies  for  reduced  fares.  The 
City  Council  has  kindly  promised  the  use  of 
the  Council  Chamber  for  the  meeting,  and  it  is 
intended,  if  possible,  to  set  aside  one  room  foi- 
the  reception  of  interesting  specimens,  patho- 
logical or  otherwise,  exhibited  by  the  members 


AN  ANNUAL  MUSEUM. 

It  has  become  a  custom  much  honoured  in 
the  observance,  in  the  last  few  years,  to  have 
at  all  large  Medical  gatherings  facilities  affoi-ded 
for  the  exhibition  of  interesting  and  instructive 
pathological  and  physiological  specimens,  gross 
and  microscopic.  Sanitary  and  surgical  appli 
anc-es  may  be  included.  We  sincerely  trust 
that  all  members  likely  to  be  present  at  the 
Canada  Medical  Association  Meeting  next 
month  will  spare  no  eflbrt  to  make  the  initia- 
tive in  this  department  a  grand  success.  Ce 
n'est  que  h  premier  pas  qui  coute. 


MEDICAL    DEPARTMENT  OF  THE 

WESTERN   UNIVERSITY. 

• 

All  arrangements  have  been  completed  for 
the  opening  of  this  new  Medical  School  in 
London,  on  the  first  of  October  next.  A 
Faculty  has  been  organized  with  Dr.  Charles  G. 
Mooie,  as  Dean  and  Lecturer  in  Surgery.  The 
other  subjects  are  distributed  as  follows : — 
Practice  of  Medicine,  Dr.  John  M.  Eraser ; 
Nervous  and  Mental  Diseases,  Dr.  Bucke  ; 
Materia  Medica  and  Pharmacy,  William 
Saunders,  F.  R.  S.  C;  Therapeutics  and  Toxi- 
cology, Dr.  J.  A.  Stevenson ;  Chemistry, 
James  Bowman  ;  Obstetrics,  Dr.  C.  S.  Moore  ; 
Physiology,  Dr.  Eccles  ;  Anatomy,  Dr.  Waugh  ; 
Clinical  Medicine,  Dr.  Arnott;  Clinical  Sur- 
gery, Dr.  Niven  ;  Histology  and  Dermatology, 
Dr.  Moorhouse  ;  Sanitary  Science,  Dr.  Jones  ; 
Medical  Jurisprudence,  Dr.  Fen  wick  ;  Demon- 
strator of  Anatomy,  Dr.  Wishart ;  Secretary, 
Dr.  Stevenson. 


PERSONALS. 


Dr.  Sheard  has  returned  from  Europe. 

Dra.  Aikins,  Covemton,  and  Graham  are  still 
in  Europe. 

Dr.  R.  A.  Reeve  will  spend  the  month  of 
August  in  the  North-West. 

Dr  A.  M.  Rosebrugh  of  Toronto,  is  spending 
his  holidays  in  Manitoba  and  the  North-West. 

Nothnagal  has  succeeded  the  late  Prof. 
Duchek  in  the  Chair  of  Medicine  in  Vienna. 

Dr.  J.  E.  Graham  (Toronto  School  of  Medi- 
cine )  has  been  appointed  Pathologist  to  the 
Toronto  General  Hospital. 

Dr.  George  Wright  and  Dr,  A.  H,  Wright, 
(both  of  the  Toronto  School)  have  been  placed  on 
the  active  staff  of  the  Toronto  General  Hospital, 

Vogt  has  been  called  to  the  Chair  of  Surgery 
in  Greifswald,  as  successor  to  the  late  Prof, 
Hueter. 

Chiari,  of  Vienna,  has  been  called  to  the 
Chair  of  Pathological  Anatomy  at  Prague,  in 
succession  to  Klebs. 

Dr.  Robert  J.  B.  Howard,  of  the  McGill 
School,  passed  the  primary  examination  of  the 
Royal  College  of  Sui-geons  of  England  on  the 
1st  ult. 


OF  MEDICAL  SCIENCE. 


277 


L)r.  E.  C.  Spitzka  has  been  elecDed  Professor 
of  Medical  Jurisprudence  and  State  Medicine 
in  the  New  York  Post-graduate  School  of 
Medicine.  Dr.  T.  V.  Clevenger,  Professor  of 
Artistic  Anatomy  in  the  Chicago  Academy  of 
Fine  Arts.  Dr.  D.  W.  Cheever,  Professor  of 
Surgery  in  the  Harvard  Medical  School. 


Juke  Examination. — Toronto  University, 
— Matriculants  in  Medicine  : — Haultain,  C.  S  ; 
Johnston,  D.  R. ;  Noecker,  C.  F.  ;  Patterson, 
C.  J.  ;  Reid,  J.  B.  ;  Farrish,  McJ .  Scholar- 
ships : — 1.  Johnston,  D.  R.,  Collingwood  Col- 
legiate Institute;  2.  Noeoker,  C.  F.,  Berlin 
High  School. 


The  death  of  Dr.  Treiber  is  announced  by 
cable  from  Athens.  He  was  the  physician  who 
attended  Byron  in  his  last  illness  at  Missolonghi 
in  April,  1824.  By  his  death  Athens  loses  the 
last  foreign  resident  who  was  engaged  in  the 
struggle  for  Greek  independence. — American 
Medical  Weekly. 

The  Announcement  of  the  Woman^s  Medical 
College  of  Baltimore. 


Johns  Hopkins  University  Circulars — Biology^ 
work  of  tite  past  year,  1881-2. 


Michigan  College  of  Medicine,  Detroit.     An- 
nouncement for  Session  1882-83. 


The  Detroit  Medical  College.     Announcement 
and  Catalogue,  1882-83. 


Toronto  School  of  Medicine.     4.0th   Annual 
Announcement,  1882-83. 


Twenty-Second  Annual  Announcement  of  the 
Bellevue  Hospital  College,  1882-83. 


Electricity  in   Medicine   and,  Surgery.     By 
T.  J.  Caldwell,  M.D. 


Thirty-Ninth  Annical  Report  of  the  Managers 
of  the  State  Lunatic  Asylum,  Utica,  N.Y., 
1881. 


McGill  University,  Montreal,  60th  Annual 
Announcement  of  the  Faculty  of  Medicine. 
Session  1882-83. 


Plastic  Splints  in  Surgery.  By  Samuel  N. 
Nelson,  A.B.,  M.D.,  Boston.  (Reprint  from 
Annals  of  Anatomy  and  Surgery,  April.) 


Genius  Resistless.  An  Ode :  A  Tribute  to 
Jenner  and  Pasteur.  By  J.  J.  Caldwell, 
M.D.,  Neurologist,  Baltimore,  Md. 

Static  Electricity  as  a  Therapeutic  Agent.  A 
paper  read  before  the  New  York  Academy  of 
Medicine.     By  James  Knight,  M.D. 


University  of  Bishop's  College.  Twelfth  An- 
nual Announcement  of  the  Faculty  of  Medicine, 
Montreal j  Session  1882-3. 

A  Contribution  to  the  Subject  of  Nerve 
Stretching.  By  Wm.  J.  Norton,  M.D.,  New 
York.  (Reprint  horn  Journal  of  Nervous  and 
Mental  Diseases.) 


The  Voice  in  Diagnosis  and  Prognosis.  By 
T.  Wesley  Mills,  A.M.,  M.D.,  L,R.C.P., 
London.  (Reprint  from  Canadian  Medical  and 
Surgical  Journal.) 

Excerpts  from  Opinions  of  DistinguisJied 
Medical  Men  in  this  and  otJier  Countries,  justi- 
fying the  treatment  of  the  late  President  Garfield. 
By  D.  W.  Bliss,  M.D. 


Report  on  Ophthalmology  to  the  Medical 
Chirurgical  Faculty  of  Maryland,  at  its  8Jf.th 
Session,  April,  1882.  By  Julien  J.  Chisholm, 
M.D. 


Combined  Intra-utei  ine  and  Extra-uterine 
Ttvin  Pregnancy,  with  an  analysis  of  twenty- 
four  cases,  and  full  Extracts  from  tJie  most  im- 
portant cases.  By  B.  B.  Browne,  M.D.,  Bal- 
timore, M.D.  (Reprint  from  Gynaxological 
Transactions.) 


Double  Irrigation  and  Drainage  Tubes. 
Uterine  Dilatation  by  Elastic  Force.  The  Cure 
of  Hernia  by  the  Antiseptic  use  of  Animal 
Ligature.     By  Henry  O'Marcy,  A.M.,  M.  D., 


278 


CANADIAN  JOURNAL 


Boston.     (Reprint   froiu  Transactions  Interna 
tional  Medical  Congress  for  1881.) 


Fourteenth  Animal  Report  of  the  Inebriates' 
Home,  Fort  Hamilton,  N.Y ,for  the  year  188 1. 
Also  a  Statistical  Report  of  Six  Hundred  Cases 
of  Alcoholic  Inebinety  treated  there  from  Nov. 
1, 1879  to  Jan.  1, 1881.  By  Lewis  D.  Mason, 
M.D.,  Consulting  Physician. 

Eighth  Annual  Beport  of  the  Secretary  of  the 
State  Board  of  Health  of  the  State  of 
Michigan  for  the  Fiscal  Year,  Ending 
Sept.  30,  1880. 

We  are  much  indebted  to  the  State  Board 
of  Michigan,  and  to  its  most  indefatigable  and 
efficient  secretary,  Dr.  Henry  B.  Baker,  for  a 
copy  of  this  very  valuable  report,  containing 
as  it  does  many  excellent  papers  and  a  mass  of 
most  interesting  and  instructive  statistical  in 
formation. 


Second  Annual  Report  of  the  Astronomer  in 
charge  of  the  Horological  and  Thermometric 
Bureaus  in  the  Observatory  of  Yale  College, 
1881-2.     By  Leonard  Waldo. 

We  are  pleased  to  learn  from  this  Repoit 
that  the  number  of  Physicians'  Thermometers 
examined  has  more  than  doubled  in  the  past 
year,  and  that  a  considerable  improvement  in 
the  manufacture  of  Thermometers  has  been 
noted.  The  amount  of  breakage  for  which  the 
department  has  been  found  responsible,  is  about 
one-tenth  of  1  jyer  cent.  There  can  no  longer 
be  found  any  excuse  for  a  physician  employing 
an  uncertain  or  unreliable  thermometei". 


A  Treatise  on  the  Physiological  and  Therapeutic 
Action  of  the  Sulphate  of  Qimiine.     By  Otis 
F.    Manson,  M.D,,   Prof,  of  Physiology  and 
Pathology,  Medical  College,  Virginia.   Phila- 
delphia :  J.  B.  Lij)pincott  &  Co.  1882. 
This    little   brochure,    of    some    160    pages, 
contains  an  entertaining  account  derived  from 
a  variety  of  sources   of  the   phyisological    and 
therapeutic  action  of  the  sulphate  of   quinine. 
This  remedy    has  grown  to  be  regarded  almost 
as  a  panacea,  and  like   all   medicines   of  that 
class     is     oftentimes     employed     irrationally, 
empirically,  injudiciously,  and  injuiiously.     It 
is  well,  therefore,  that  its  extravagant  use  should 
be  curtailed  by  a  due  appraisement  of  its  virtues 


and  capabilities.  If  in  the  attempt  we  can 
learn  somthing  of  its  proper  use,  and  mode,  and 
time  of  use,  so  much  the  better.  As  an  honest 
contribution  to  this  end  we  commend  the  book. 


Minutes  of  tlie  Proceedings  at  the  Sixth  Annual 
Meeting  of  the  American  Gyncecological 
Society. 

This  meeting  was  held  in  New  York,  in  Sep- 
tember 1881,  and  we  are  pleased  to  find  the 
minutes  of  the  proceedings,  included  with 
the  reading  of  papers  and  the  discussions 
thereon,  recorded  in  tiie  j)resent  vohinie. 
Although  much  of  the  subject  matter  is  not 
new  at  the  present  time,  having  been  already 
published  in  the  Journals,  still  we  are  glad  to 
see  the  continued  publication,  year  after  year, 
of  the  pioceedings  of  a  society  which  is  second 
to  none  in  the  world  in  this  important  branch 
of  medicine.  We  have  in  this  Province  very 
few  gynaecologists  proper,  but  our  general 
practitioners  are  taking  much  more  interest  in 
the  subject  now  than  lormerl}-,  and  in  their 
treatment  are  guided  chiefly  by  the  American 
spicialists.  We  are,  therefore,  unusually  interest- 
ed in  everything  done  by  this  society  and 
proper tiouately  pleafced  to  have  the  opportunity 
of  obtaining  these  "reports  "  which  are  got  up 
in  such  a  way  as  to  be  a  credit  to  the  pub- 
lishers, and  to  the  indefatigable  and  genial 
secretary.  Dr.  Chadwick. 


Atkis  of  Gynaecology  and  Obstetrics.  By  Dr- 
E.  Martin,  Professor  of  Gynaecology  at  the 
University  of  Berlin,  and  Dr.  J.  P.  May- 
GRIER,  Membie  de  I'Acadeuiie  Royale  de 
Medicine,  Professeur  de  Accouchements,  con- 
taining 475  plain  and  35  coiourod  illustra- 
trations.  A.  E.  Wilde  &  Co.,  Cincinnati, 
publishers. 

These  drawings  are  from  the  original  designs 
of  the  master  names  in  English,  French,  and 
German  obstetrics  and  gynaecology  and  path- 
ology. Tiie  explanatory  text  is  translated  and 
edited  with  additions  by  VVm.  A.  Rothacker, 
M.D.,  Pathologist  to  the  Cincinnati  Hospital. 
The  Atlas  is  designed  as  a  hand-book  sup- 
plementary to  the  text  books  and  treatises  in 
general  use,  and  is  issued  in  15  parts  for  the 
moderate  sum  of  $1  per  part.  We  are  just  in 
receipt  of  Parts  VI.  to  XV.  inclusive,  and 
having  regard  to  the  way  in  which  the  work 


OF  MEDICAL  SCIENCE. 


279 


Las  been  couipluted  have  no  leasou  to  uiediiy 
the  high  encomiums  we  passed  upon  the  first 
four  numbers.  It  would  be  impossible  in  our 
limited  space  to  give  an  account  of  the  work 
in  detail,  but,  speaking  in  a  general  way,  we 
have  no  hesitation  in  saying  that  it  is  the  best 
work  of  its  kind  we  have  yet  seen.  Doubtlesa, 
in  some  instances,  there  is  room  for  improve- 
ment both  in  the  selection  of  the  subject  illus- 
trated and  the  illustration  itself;  but  until 
something  better  is  produced  we  must  award 
the  palm  where  the  highest  excellence  is  to  be 
found. 

Clinical  Lectures  on  Diseases  of  the  Urinary 
Organs.  By  Sir  Henry  Thompson.  Six*h 
London  edition.  Illustrated  with  73  wood 
engravings.  London:  J.  «fe  A.  Churchill. 
Philadelphia:  P.  Blakiston,  Son  &  Co. 
Toronto:  N.  Ure  &  Co.,  5  King  Street 
West. 

This  well-known  text  book  which  has  been 
translated  into  five  languages,  and  is  universally 
recognised  as  the  best  treatise  on  the  subject 
in  six,  needs  no   further   commendation  than 
the    announcement    of   a   sixth    edition.     The 
general  superiority  and  other  special  merits  of 
this   edition    may    be    stated    in    the   author's 
words  :     "  Among  several  important  additions, 
the  modern  operation  of  Lithotrity  at  a  single 
sitting,  is  fully  considered  and  illustrated,  and 
is  regarded  as    superseding  the  old  operation, 
and    to    a    great     extent     the    operation    of 
Lithotomy.     *  *  *  *  H^    I  venture  to  believe 
that  my  intention  has  been  more  fully  realized 
in  this  volume  than  in  any  of  its  predecessors. 
I  have  also   thought   it   desirable  to  follow  a 
course  which  has  been  recently  pursued  with 
manifest  advantage  to  the   public,  in  works  of 
general  literature,  and  have  issued  this  edition, 
which    is   more    comprehensive    and    complete 
than  any  previous  one,  at  less  than  a  fourth  of 
the  former    price,  so  as    to  bring   it  within  the 
reach  of  all  students."     The   modest  sum    de- 
manded for  this  volume  is  85  cents — a  price  at 
which    no  student  or  practitioner  in  however 
straitened  circumstances    can  afford  to  be  with- 
out it.     We  trust  that  other  wealthy  medical 
writers   will  not  be  slow  to  imitate    the  good 
example  thus  set  by  the  most  eminent  lithotri- 
tist  of  the  age.    Longum  iter  est  per  prcecepta, 
breve  et  efficxix  per  exempla. 


pe^tiugs  of  Petlial  ^mti\t%. 


MEETING    OF  THE    BATHURST   AND 
RIDEAU  MEDICAL  ASSOCIATION. 

The  Bathurst  and  Rideau  Medical  Associa- 
tion held  their  annual  meeting  at  Smith's  Falls 
on  Wednesday,  June  28th,  in  the  Town  Hall. 
There  were  present  Dr.  J.  G.  Cranston,  of 
Arnprior,  President,  Drs.  Hill,  Grant,  Sweet- 
land,  H.  P.  Wright,  Horsey,  H.  B.  Small, 
Secretary,  and  Powell,  of  Ottawa.  Dr.  B^ird, 
Pakenham,  Drs.  Burns  and  Lynch,  Almonte, 
Dr.  Preston,  of  Carleton  Place,  Drs.  Atcheson 
and  McCollum,  of  Smith's  Falls.  Dr.  A.  Mal- 
loch,  of  Hamilton,  who  happened  to  be  in 
Smith's  Falls  on  a  visit,  also  attended  the  meet- 
ing. 

The  President  gave  a  short  and  interesting 
address,  alluding  feelingly  to  the  deaths  of  Dr. 
Blackwood, of  Pakenham,andDr.  Weir, of  Mer- 
rickville.  He  then  gave  an  account  of  the  late 
meeting  of  the  Medical  Council,  and  concluded 
by  asking  all  present  to  revive  the  Association 
which,  during  the  past  three  years,  has  gradu- 
ally been  dwindling  in  size  and  importance. 

The  election  of  officers  was  then  proceeded 
with  and  resulted  as  follows  : 

Dr.  J.  G.  Cranston,  President  elect. 
Dr.  Horsey,  of  Ottawa,  and    Dr.  Burns,  Al- 
monte,  Vice-Presidents. 

Dr.  Hill,  Ottawa,  Treasurer. 
Dr.  Small,  Ottawa,  Secretary. 
Drs.  Grant,  Sweetland,  and  H.  P.  Wright,  of 
Ottawa,  and  Dr.  Dickson,  Pembroke, Dr.  Lynch, 
Almonte,    Dr.    McCollum,  Smith's  Falls,    Dr. 
Baird,  Pakenham,  were  elected  as  the  Council. 
The  only  prepared  paper  was  one  by  Dr.  R. 
Powell,  of  Ottawa,  entitled  "  The  Significance 
of  Cardiac  Murmurs."      He   dealt  chiefly  with 
the  pathology,  physical  signs,  and  relative  im- 
portance of  murmurs. 

A  few  questions  on  the  paper  were  put  by 
Drs.  Small  and  Hill,  and  replied  to  by  Dr. 
Powell.  The  usual  vote  of  thanks  was  moved 
by  Dr.  Hill,  and  seconded  by  Dr.  Grant,  and 
tendered  by  the  Chairman  to  Dr.  Powell. 

Dr.  Grant  then  addressed  the  meeting,  advo- 
cating a  system,  too  much  neglected,  of  the 
family  physician  being  allowed  to  examine  his 


280 


CANADIAN  JOURNAL 


regular  patieuts  thoroughly,  at  least  once  in  two 
years,  so  as  to  enable  him  to  detect,  and  if  pos 
sible,  check  approaching  disease.  This  process 
he  termed  "  keel-hauling." 

Dr.  H.  P.  Wright  then  related  an  interesting 
case  of  phantom  tumour  which  occurred  recently 
in  his  practice.  This  case  will  no  doubt  be 
submitted  to  the  profession  in  a  more  promi. 
nent  way  shortly. 

Dr.  J.  G.  Cranston  then  gave  a  short  account 
of  a  case  of  elongation  and  hypertrophy  ot  the 
cervix  uteri  of  remarkable  interest,  which  he  has 
at  present  under  observation.  The  case  is 
probably  unique,  and  will  deserve  publication 
•whether  operated  on  or  not.  We  will  look  for 
an  early  report. 

The  Society  then  adjourned  to  meet  in  Ot- 
tawa in  January,  1883.  Five  of  the  members 
were  requested  to  prepare  papers. 

Dr.  Atchibon  then  entertained  the  members 
at  a  convenient  resort,  when  the  customary 
"  you  scratch  my  back  and  I'll  scratch  yours  " 
was  gone  through,  accompanied  by  happy 
speeches  and  felicitous  responses.  The  deten- 
tion of  the  C.P,R  train  for  two  hours  was  in 
this  case  a  happy  accident. 


MEETING  OF  THE  PROVINCIAL 
BOARD  OF  HEALTH. 

A  Meeting  of  the  Provincial  Board  of  Health 
was  held  in  the  Parliament  Buildings,  27th 
June.  Present — Dr.  Oldright,  in  the  chair, 
Drs.  Cassidy,  Rae,  and  Hall,  and  Dr.  Bryce, 
Secretary. 

Several  communications  were  read,  amongst 
them  being  one  from  Dr.  Baker.  Michigan 
Board  of  Health,  as  to  the  time  lequiied  for 
the  compilation  of  weekly  health  reports ;  one 
from  Mr.  Henry  Hughes,  Sanitary  Inspector, 
Lindsay,  as  to  various  nuisances  existing  in 
that  town,  and  another  from  Mr.  Milroy, 
as  to  an  epidemic  of  low  fever  and  ague  in 
Coboconk. 

CONSIDERATION    OF    REPORTS. 

Dr.  Rae  read  a  report  containing  certnin 
recommendations  to  the  Government  on  the 
subject  of  inspection  of  immigrants,  which  was 
considered  in  Committee  of  the  Whole,  and 
adopted  with  slight  amendments. 

The  Chairman  read    an  exhaustive  report  on 


the  sewerage  and  water  supply  of  this  city, 
particularly  referring  to  the  necessity  of  con- 
structing a  covered  drain  at  the  Garrison  creek, 
the  draining  of  University  creek,  and  the  re- 
construction of  Sherbourne-street  sewer.  The 
report  embraces  certain  recommendations  on 
ihese  and  other  subjects,  so  as  to  strengthen 
the  hands  of  the  City  Engineer  in  carrying  out 
these  improvements  on  sanitary  grounds. 

RESOLUTIONS    PASSED. 

It  was  moved  by  Dr.  Cassidy,  seconded  by 
Dr.  Hall,  and  carried,  "  That,  whereas,  it  is 
the  opinion  of  this  board  that  contagious 
diseases  frequently  originate  on  shipboard 
solely  from  impure  air,  be  it,  therefore,  resolved 
thai)  it  is  a  matter  of  great  moment  for  the 
prevention  of  such  diseases  that  ships  should  be 
constructed  with  a  view  to  thorough  ventilation, 
that  in  no  case  should  hatches  be  closed  without 
means  being  j)rovided  for  the  circulation  of  pure 
air  in  the  meantime,  and  that  the  Government 
should  insist  on  measures  to  secure  such  an 
end." 

It  was  moved  by  Dr.  Rae,  seconded  by  Dr. 
Cassidy,  and  carried,  "  That  Dr.  Covernton  be 
commissioned  to  attend  the  Congress  of 
Hygiene  to  be  held  at  Geneva  from  the  4th  to 
9th  September  next." 

On  motion,  the  Secretary  was  commissioned 
to  visit  Boston,  Albany,  and  New  York  for 
the  purpose  of  procuring  information  on  sani- 
tary matters,  ad  as  to  the  introduction  of  a 
vaccine  farm.  The  subject  of  the  introduction 
of  the  teaching  of  Hygiene  in  schools,  as 
recommended  by  the  Ontario  Medical  Associa- 
tion, was  introduced  by  Dr.  Oldright,  but 
action  thereon  was  deferred  till  a  subsequent 
meeting. 

Several  other  routine  matters  were  consid- 
ered, and  the  board  adjourned. 


Insecticide  Lotion. — F.  Benvenuti. — Dried 
flowers  of  the  larkspur,  3  grammes,  water  100. 
Macerate  for  36  hours  and  strain.  The  in- 
odorousand  highly-coloured  liquid  thus  obtained 
is  employed  as  a  lotion  to  destroy  the  pediculi 
pubis.  Vinegar  may  be  substituted  for  the 
water.  Two  lotions  have  constantly  sufficed  to 
destroy  the  lice  and  their  eggs,  without  giving 
rise  to  either  burning  or  itching. — V  Union 
Med. 


OF  MEDICAL  SCIENCE. 


281 


MEETING  OF  NOVA  SCOTIA  MEDICAL 
SOCIETY. 

The  Thirteenth  Annual  Meeting  of  this 
Society  was  held  at  Kentville,  N.S.,  June  28Lh 
and  29th,  the  Vice-President,  Dr.  McPherson, 
of  North  Sydney,  being  in  the  Chair.  The 
meeting  was  an  interesting  one  and  some  of 
the  discussions  were  quite  animated. 

On  the  second    day  the   profession  of   Kings 

!  County  gave  them  a  hmchecn,  after  a  drive  to 
North  Mountain.  The  officers  appointed  for 
next  year  were:  President,  Dr.  W.  B.  Slayter, 

^of  Halifax;  1st  Vice-President,  Dr.  H.  13. 
McPherson,  North  Sydney  ;  2nd  Vice-P.  esi- 
dent,  Di'.  H.  Shaw,  Kentville;  Secrettrj- 
Treasurer,  Dr.  J.  Somers,  Halifax.  It  wax 
decided  to  hold  the  next  meeting  at  Truro  on 
the  third  Wednesday  in  June,  1883. 


TORONTO  MEDICAL  SOCIETY. 

May  18th,  1882.— The  S 'ciety  met  at  8.20, 
the  President,  Dr.  Geo.  Wright,  in  the  clmir 
Alter  reading  of  minutes  of  last  meeting  the 
:  President  delivered  his  inaugural  addres?=,  in 
which  he  reviewed  the  history  of  the  Society 
from  its  inception  f->ur  years  ago,  dwelling  on 
the  advantages  afforded  by  such  an  association, 
for  the  discusfcion  of  all  matters  of  scientific 
importance  to  the  profe  sion.  He  deprecated 
the  diffidence  sometimes  shown  by  the  members 
in  furnishing  papers,  and  expressed  the  hope 
that  the  current  year  may  be  one  of  gratitying 
prosperity. 

Dr.  Reeve  then  read  an  exhaixstive  and  practi- 
cal paper  on  "  Diseases  of  the  Eye,'  a  full  i  eport 
of  which  has  appeared  in  the  Journal. 

Dr.  Cameron  exhibited  a  case  of  squamo- 
pustular  syphilide  on  the  forearm  of  a  washer- 
woman. 

Dr.  Oldright  related  a  case  of  paracentesis 
thoracis,  in  which  there  were  alarming  symp- 
toms, owing  to  a  too  rapid  exhaustion  of  the 
fluid  in  the  pleural  cavity. 

After  some  miscellaneous  business  the  Society 
adjourned. 

June  1st,  1882.— The  Society  met  at  8  25, 
the  President  in  the  chair. 


Drs.  Sweetnam,  Stark,  and  Riordan,  were 
elected  members  of  the  Society. 

Dr  McPhedran  read  a  paper  on  acute  peri- 
tonitis, treating  of  the  etiology  and  treatment. 
—{Vide p.  262.) 

Br.  Macdonald  exhibited  an  instrument  de- 
vised for  twisting  wire  sutures  in  places  difficult 
of  access. 

Dr.  Oldright  pres mted  to  the  Society  the 
photograph  and  notes  of  a  pathological  specimen, 
shown  at  the  Ontario  Medical  Association, 
June,  1881. 

After  miscellaneous  busines-*,  the  Society  ad- 
journed. 


Piisialtoeouisi. 


Smallpox  in  Birds  and  Poultry. — The 
Pittsburgh  Medical  Journal  states  that  Di'. 
Hewson,  of  Philadelphia,  has  t  aofd  the  source 
of  cases  of  smallpox  to  the  Engli>h  f])arrow,  in 
whose  houses  he  has  invariab'y  found  evidences 
of  ihe  disease.  Also  the  Eaiior  of  that  journal 
saw,  in  1849,  smallpox  inpoult>y,  covering  'he 
head  and  cjinbs  of  the  fowls,  and  quotes  an  ex- 
tract from  the  British  Medical  Journal,  in  which 
it  is  stated  that  variola  in  India  is  prevalent 
amongst  the  pigeons  and  poultry. 


Therapeutic  Memoranda.  —  Dr.  John 
Meredith,  in  the  Birmingham  Medical  Review, 
extols  oil  of  peppermint  as  an  external  applica- 
cation  in  herpes  zoster,  both  for  the  neuralgic 
pains  often  so  piteously  complained  of  after  the 
eruption  has  disappeared,  and  as  an  aj^plication 
over  the  eruption  in  its  fresh  florid  condition. 
Dr.  Cambillard  (Covrrier  Medical)  recommends 
for  chorde  ■  an  injection  4ter  die  and  repeated 
just  before  going  to  bed,  composed  of  pot. 
brom.  gr.  80;  glycerin  J^i  ss  laudanum  3i 
water  5ivsp.  Dr.  Nowatschek  reports  favour- 
ably of  the  use  of  atropine  either  internally  or 
hypodermically  (into  the  perineum)  in  sp-^rma- 
torrhoea. 

.Esthetics  in  Cathartics. — Buntboi-ne,  the 
"fleshly  poet,"  in  the  new  opera  "  Patience," 
gives  the  following  as  "  a  wild,  weird,  fleshly 
thing,   yet   very  yearning,  very  precious.     To 


282 


CANADIAN  JOURNAL  OF  MKDICAL  SCIENCE. 


understand  it,  cling  passionately  to  one  another 
and  think  of  faint  lilies  :" 

What  time  the  poet  hath  hymned 

The  writhing  maid,  lithe  limbed, 
Quivering  on  amaranthine  asphodel, 

How  can  he  paint  her  woes, 

Knowing,  as  well  he  knows, 
That  all  can  be  set  right  with  calomel  7 

When  from  the  poet's  plinth 

The  amorous  colocyntb 
Yearns  for  the  aloe,  faint  with  rapturous  thrills, 

How  can  he  hymn  their  throes. 

Knowing,  as  well  he  knows, 
That  they  are  only  ancompounded  pills  ? 

It  is,  and  can  it  be 
Nature  hath  this  decree, 
•'  Nothing  poetic  in  the  world  shall  dwell  ?'" 
Or  that  in  all  her  works 
Something  poetic  lurks. 
Even  in  colocynth  and  calomel  ? 
I  cannot  tell. 

— Michigan  Medical  Neioa. 


Dr.  Holmes  on  Homoeopathy.  —  In  a 
late  address,  Dr.  Holmps  gives  the  following 
estimate  of  homoeopathy,  the  careful  study  of 
which  we  commend  to  the  supporters  of  the 
New  York  Code :  "  Homoeopathy  has  no  status 
among  the  biological  sciences,  and  has  nothing 
of  any  practical  value,  so  far  as  1  know,  to  offer 
the  medical  profession.  It  began  by  promising 
to  prevent  scarlet  fever,  which  it  miserably 
fails  to  do,  and  from  that  day  to  this  it  has 
been  a  romance  of  idle  promises  slipping 
through  the  fingers  like  quicksilver,  evapora- 
ting without  residue  like  ether  from  the  palm 
of  the  hand.  If  any  one  of  these  promises  had 
been  fulfilled,  if  any  single  remedy  brought 
forward  by  homceopathy  had  proved  trust- 
worthy and  efficacious,  it  would  have  been 
thankfully  accepted  by  the  medical  profession, 
which  welcomes  every  method  of  help  unless  it 
shows  itself  with  false  pretences,  and  even 
then  will  appropriate  any  fraction  of  truth 
which  underlies  the  deception  or  delusion.     .    . 

'*  So  far  as  I  cati  take  account  of  the  stock, 
the  present  assets  of  homceopathy  consists  of 
a  pleasing  and  sonorous  designation,  a  nomen- 
clature of  symptoms,  with  sets  of  little  phials, 
containing  globules,  whioh  are  the  prettiest  and 
most  fascinating  of  amulets,  arranged  to  cor- 
respond with  the  nomenclature,  a  collection  of 


*'  provings  "  which  prove  more  about  the  prover 
than  about  the  questions  to  be  proved,  and  a 
doctrine  which  slips  on  and  off  like  a  kid  glove, 
according  to  the  company  in  which  the 
l)ractitioner  finds  himself." — Medical  News. 


THE  MAN  SNAKE. 

In  the  village  of  Cuantln,  Mexico,  says  a  re- 
cent number  of  La  Independencia  America, 
Vielonging  to  the  Canton  of  Antlan,  lives  an 
individual  whose  scaly  skin  is  in  every  way  like 
that  of  the  rattlesnake,  even  to  the  greenish 
col'nir ;  possessing,  besides  the  property  of 
changing  his  skin  every  autumn;  such  phenom- 
enon being  accomplished  all  at  once,  and  not 
by  parts,  so  that  the  entire  body  is  left  like  what 
is  vulgarly  called  Tuwon,  (a  smooth  leather  bag, 
flesh  side  out),  and  not  even  a  single  hair  is  left. 
A  sister  of  this  individual,  who  died  a  short 
time  ago,  manifested  the  same  phenomena  and 
became  gradually  blind,  for  the  new  skin  went 
on  covering  the  eye- lids  together  in  a  circular 
form,  until  the  eyes  themselves  were  covered. 
The  same  thing  is  happening  to  the  man  who  is 
living,  who  has  already  some  small  circles,  that 
only  permit  him  with  difficulty  to  see  and  dis- 
tinguish surrounding  objects.  Thus  he  presents 
the  repugnant  figure  of  the  head  of  a  rattle- 
snake. In  Cuantla,  these  unfortunate  people 
are  known  by  the  name  of  "  the  rattlesnake 
man  and  woman,"  and  their  appearance  is  at- 
tributed to  the  fact  that  their  mother  had  eaten 
too  much  rattlesnake  to  cure  herself  of  a  dis- 
ease of  the  blood.  [Rupia,  most  likely,  Trans- 
lator.^ Whatever  the  phenomenon  may  be,  it 
is  worthy  of  study.  Would  that  the  man  could 
bo  induced  to  come  to  this  capital  (the  city  of 
Mexico),  in  order  that  his  disease  might  be 
studied  by  the  members  of  the  profession  ! 

A.  A.  R. 


MAUUIKl). 

At  "  Hillside,"  Brantford  Township,  at  the  residence 
of  the  bride's  father,  by  Rev.S.  Sellcry,  B.D.,on  the  29th 
of  May,  J.  Willniot,  M.D.,  of  Charlotte,  Mich.,  to 
Martha  V. ,  third  daughter  of  N.  Lee,  Esq. 

DEATH. 

At  Simcoe,  on  the  28th  July,  John  Salmon,  M.D., 
aged  52  years. 


THE 


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Canabian  ^^mxml  of  ^Jebital  ^tmtt 

A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


U.  OGDEN,  M.D., 

R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond., 


\  Consulting  Editors. 


A.  H.  WRIGHT,  B.A.,  M.B.,  M.R.C.S.,  Eng., )  ^j,.^ 
I.  H.  CAMERON,  M.B.,  ' 


SUBSCRIPTIOIV,   $3    PER    ANIVIJITI. 


iS"  All  literary  communications  and  Exchanges  should  be  addressed  to  Dr.  CAMERON,  273  Sharbourne  St. 

or,  Dr.  WRIGHT,  313  Jarvis  St. 
US'  All  busineas  communications  and  remittances  should  be  addressed  to    HART  ft  COMPANY,  Publishers, 

31  and  33  King  Street,  Toronto. 


TORONTO,  SEPTEMBER,  1882. 


THE  CAUSES  AND  CONSEQUENCES 
OF  DEFECTIVE  VISION  DURING 
SCHOOL  LIFE. 

BY  L.  L.  PALMER,  M.D.,  TORONTO. 

(Read  before  the  Ontario  Medical  Association, 
June,  1882.) 

It  was  not  my  intention  to  take  up  the  time 
of  this  Association  this  year  with  a  paper,  until 
about  a  week  ago,  our  worthy  President  sug- 
gested to  me  that  I  write  up  the  subject  of 
hygiene  of  schools,  which  in  its  importance  so 
commended  itself  to  my  judgment,  that  I  have 
undertaken  to  consider  at  least  one  phase  of  the 
question  which  may  form  a  nucleus  for  further 
thought — a  phase  by  no  means  the  least  im- 
portant of  all  the  conditions  that  affect  early 
life — viz..  The  Causes  and  Consequences  of 
Defective  Vision  during  School  Life. 

It  is  now  admitted  by  all  who  study  Ophthal- 
mology, that  the  pressing  danger  of  the  eye  dur- 
ing early  life  is  myopia,  or  shortsightedness,  the 
organic  cause  of  which  is  too  great  a  depth  of 
the  crystal,  which  causes  the  sharp  image  of 
an  object  to  form  in  front  of  the  retina  instead 
of  upon  it.  It  is  commonly  observed  by 
teachers  and  parents  that  school  work  is  often 
associated  with,  and  even  hindered  by,  impaired 
vision,  but  that  it  is  an  evil  much  to  be  guarded 
against  and  a  danger,  in  many  instances,  truly 
alarming  has  not  appeared  to  them. 

If  an  ounce  of  prevention  is  worth  a  pound 
of  cure,  and  this  more  valuable  pi-evention  in 
the  light  of  present  science  and  research  is 
more  easily  possible  ;  if  the  children  of  to-day 
are  the  men  and  women  of  twenty  years  hence, 


then  it  becomes  us  to  turn  our  scientific  labour 
and  much  thought  to  the  well-being  of  children, 
and  see  that  their  physical,  as  well  as  their  men- 
tal health,  be  properly  guarded  against  dangers 
generally  unobserved.  Delicate  as  is  the  eye, 
it  will  when  emmetropic,  and  in  a  state  of 
health,  bear  any  amount  of  use,  but  when  it 
has  lost  its  balance,  or  its  normal  proportions, 
its  work  is  done  with  effort  and  but  imper- 
fectly, and  it  rarely  can  be  brought  back  to  its 
original  perfection  of  action,  but  is  prone  to 
lapse  into  still  greater  disability  of  function,  or 
even  into  actual  disease. 

It  is  found  from  the  collected  statistics  of 
well-known  scientists,  such  as  Enissman,  of 
St.  Petersburg ;  Conrad,  of  Konigsberg  ;  Lor- 
ing  and  Darby,  of  New  York ;  and  Cohn  and 
Just,  of  Germany,  and  others,  that  myopia  is 
congenital  only  in  a  small  proportion  of  cases, 
that  most  children,  up  to  5  or  6  years  of  age, 
have  normal  vision,  and  from  this  age  up  to  15, 
or  according  to  Donders,  20  years,  is  the  period 
of  development  of  myopia  ;  that  few  are  myopic 
before  this  period,  and  fewer  still  if  any  become 
so  after ;  and  this  is  the  age  when  children  are 
pressed  into  school  and  are  forced  to  endure  all 
the  pains  and  penalties  of  the  cramming  system, 
in  these  days  too  common,  which  aim  at  in- 
tellectual development  at  the  cost  of  impaired 
vision,  and  sometimes  almost  of  complete  loss 
of  sight,  if  indeed  it  does  not  defeat  itself  in 
gaining  the  end  it  seeks. 

While  these  years  from  six  to  twenty — the 
school  life  of  children — is  the  period  when 
myopia  becomes  developed,  it  is  also  established 
by  careful  and  extensive  statistics  from  the 
examination  of  over  20,000  school  children, 
that  the  defect  increased  numerically  as  the  pupil 


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advanced  through  the  different  grades  of  the 
schools.  Cuhn,  of  Bnslau,  found  67  [>er  cent, 
of  myopia  in  the  ( lenientaiy,  10  3  in  the  inter- 
mediate, 19  7  in  the  high  schools,  and  26  2  in 
the  gymnasia. 

Other  authojities  quoted  above  have  made 
himilar  investigations  with  like  results ;  and 
among  the  causps  assigned  for  this  uniform 
development  of  it  are  imperfect  light,  impure 
air,  bad  construction  and  arrangement  of  desks 
and  seats,  badly  pi  inted  books;  all  these  condi- 
tions are  found  acting,  not  alone,  in  the  school- 
room, but  at  home,  when  the  child  returns  with 
a  task  to  perform,  which  taxes  the  eyes  to  a 
late  hour,  or  after  the  preparation  for  the  next 
day  is  completed.  How  often  do  we  find  the 
young  person  engaged  with  a  thrilling  story, 
or  a  fascinating  romance,  willing  to  sit  iu  any 
remote  corner  of  the  room,  and  strain  o\  er  a 
badly-printed  and  badly-illumined  page.  Con- 
ditions unfavourable  to  the  strongest  eyf> 
but  most  damaging  to  one  predisposed  by 
heredity,  or  otherwise,  to  myopii.  In  ad- 
dition to  the  above  facts  it  is  found  that 
it  is  more  especially  proper  to  cultivated 
nations,  while  an  uneducated  people  and  bar- 
barous tribes,  are  almost  entirely  free.  The 
Germans  are  said  to  show  a  greater  number  of 
myopias  than  any  oUier  country.  So  much  is 
this  the  case  that  any  passing  traveller  through 
the  states'of  Europe,  must  observe  that  specta- 
cles form  a  notable  feature  in  the  German 
physiognomy.  This  points  at  once  to  their 
high  intellectual  status,  to  their  indefatigable 
labour  in  intellectual  pursuits,  and  the  bad 
hygiene  of  their  schools  and  school  system, 
conditions  existing  in  unchecked  opera' ion 
through  all  their  history.  There  is  a  general 
agreement  among  authorities  that  a  great  de- 
velopment, or  increase,  of  it  taken  plaosdiiiii^ 
school  life,  and  the  result  is  largely  due  to 
preventable  causes.  Brudenell  CAittr  sayh  : 
"  There  is  no  longer  any  room  for  doubt,  tliai 
Vjadly-lighted  and  badly-fitted  schools  foim  a 
a  great  machinery  for  the  development  of 
myopia. 

And  it  is  possible  that  this  machinery  where, 
as  in  Germany,  it  has  for  a  long  time  been  in 
unchecked  operation,  may  have  an  important 
influence  upon  the  form  of  the  eyeball,  which 


will  be  inherited  by  large  numbers  of  the  popu- 
lation." 

Other  authorities  make  similar  statements. 
Ribot  urges  that,  "  since  constant  study  creates 
myopia  and  heredity  most  frequently  per- 
petuates, the  number  of  shortsighted  persons 
must  necessarily  increase  in  a  nation  devoted 
to  intellectual  pursuits  ;  "  and  Dr.  Loring  goes 
still  fui-ther,  by  saying,  that  "  if  by  a  nation 
devoted  to  intellectual  pursuits,  we  mean  that 
compulsory  education  shall  be  carried  out  in 
the  full  extent  of  its  original  meaning,  and 
applied  to  every  child  that  is  born,  be  it  male 
or  female  ; "  and  if  Germany  is  going  to  be 
taken  as  the  type,  and  every  other  nation 
desirous  of  intellectual  progress  be  compelled  to 
follow  her  lead  as  an  example,  then  I  am  of 
the  opinion  that  not  only  the  educated  classes, 
as  the  term  is  commonly  understood  at  pre- 
sent, but  that  the  world  at  large  will,  in  time, 
become  near-sighted."  If  such  views,  original 
and  startling  as  they  appear,  are  near  the 
truth,  it  becomes  a  matter  of  national  import- 
ance to  see  wherein  the  school  and  its  hygienic 
and  ai-chitectural  conditions  act  as  a  cause  of 
near-sight,  and  discovering  the  cause,  if  possible, 
to  remove  it. 

It  is  not  my  intention  to  construct  a  model 
school  room,  much  less  a  model  home,  this  can 
be  better  done  elsewhere.  But  I  may  be  per- 
mitted to  mention  in  brief  a  few  of  the  condi- 
tions causing  myopia  that  are  common  to  both 
school  and  home  life  of  the  young, 

(a)  Abad  light  is  one  of  the  mostcertain  causes, 
situated  as  it  too  often  is  in  front  of  the  pupil 
or  at  his  fcide,  shining  with  a  glare  on  a  level 
with  the  eye,  producing  great  irritation  which 
ii  the  precur-sor  of  a  progressive  myopia. 

(li)  Anything  favorable  to  congestion  of  the 
head,  as  a  bad  position  of  the  body,  which  is 
t)0  often  a  necessity  from  badly  constructed 
desks  and  seats,  or  which  is,  perhaps,  a  matter 
of  choice  when  the  pupil  of  studious  habits 
gets  in  the  corner  at  home,  and  with  book  in 
the  lap  and  bent  trunk  he  pores  over  it  till  a 
late  hour. 

Under  this  head  might  be  included  heat  of 
room,  wet  feet,  cold  floor,  indigestion,  excessive 
length  or  intensity  of  study  without  interrup- 
tion. 


OF  MEDICAL  SCIENCE. 


285 


(c)  Excessive  tension  of  the  eyes  for  neai- 
objects,  as  when  book  is  brought  too  near  the 
eye  for  hours  daily  throughout  an  educational 
career. 

(d)  "  Peculiarities  of  food,  indifference  to 
ventilation,  disregard  of  other  hygienic  re- 
quirements, want  of  outdoor  exercise,  and  a 
peculiar  tendency  toward  a  sedentary  life, 
all  of  which  are  provocative  of  a  certain 
laxity  of  tissiie  and  want  of  resistance  in  the 
investing  membranes  which  finds  its  expression 
in  the  eye,  in  a  distension  which  is  in  fact 
myopia."  (Loring.)  We  need  not  go  far  to 
show  that  all  these  conditions  are  largely 
present  during  school  life,  and  it  has  been 
abundantly  shown  that  the  rapidity  of  develop- 
ment of  myopiais  in  proportion  to  theirpresence 
and  to  the  early  age  at  which  children  are 
pressed,  either  by  authority  or  natural  inclina- 
tion with  studious  habits,  regardless  of  their 
optical  condition. 

Alarming  as  the  facts  appear  to  the  ophthal- 
mic surgeon,  and  important  as  is  the  eye  in  its 
intellectual,  apprehensive,  and  discriminating 
powers,  yet  there  is  no  organ  in  the  body 
guarded  with  so  little  care,  and  strange  to  say, 
its  greatest  weakness  is  popularly  counted  its 
strength.  We  often  see  myopes  comfort  them- 
selves by  saying  that  short-sighted  eyes  are 
strong,  or  healthy  eyes ;  on  the  contrary  a  short- 
sighted eye  is  a  sick  eye,  a  diseased  eye,  and  is 
very  likely,  from  the  habits  it  engenders,  to 
make  a  sickly  body ;  quite  as  much  a  dis- 
eased condition  is  it  as  an  hypertrophied 
heart  and  as  little  able  to  perform  its  functions, 
and  we  watch  a  case  of  myopia  with  as  much 
interest  and  anxiety  as  you  do  first  an  hyper- 
trophied and  then  a  dilated  heart  subsequent 
to  repeated  attacks  of  asthma.  It  aflfects  the 
physical,  mental,  and  moral  development  of  the 
child.  The  ordinary  sports  or  plays  of  the  cam- 
pus are  quite  too  much  for  him.  The  cricket,  the 
base-ball,  or  the  lacrosse  have  requirements  be- 
yond his  range  of  vision,  and  in  these  he  is  una- 
ble to  compete  successfully  with  his  fellows,  so 
with  a  sense  of  incapacity  he  retires  from  the 
field  where  the  mind  gets  its  reci'eation  and  the 
body  its  health  and  seeks  his  pleasure  and  his 
recreation  in  his  books.  This,  though  at  first 
a  pastime,  soon  becomes  a  passion  and  he  be- 


comes a  book-worm,  engorged  with  much  that 
an  age  of  rapid  printing  can  supply  without 
taking  time  to  reflect  or  digest  what  he  has 
received.  He,  therefore,  suflfers  a  kind  of  mental 
dyspepsia  which  is,  to  say  the  least,  no  evi- 
dence of  mental  strength — a  condition  as  foreign 
as  possible  to  a  true  educational  process  which  is 
the  application  of  thought  or  the  develop- 
ment of  the  processes  of  reason. 

A  fond  parent  encourages  these  so-called 
studious  habits  which  become  more  a  habit 
than  a  desire  for  the  acquisition  of  knowledge, 
and  entertain  a  strong  hope  that  the  future 
will  realize  brilliant  literary  accomplishments  ; 
but  the  defect  of  sight  is  operative  at  all  times  ; 
he  becomes  retiring,  diffident,  hesitating,  and 
cautious.  His  means  of  acquiring  knowledge, 
through  outward  objects  have  been  limited  to 
a  very  narrow  field,  his  own  small  field  of 
vision.  He  can  see  all  the  beauty  of  a  rose  or 
a  violet,  but  a  beautiful  landscape  or  the 
autumn  tints  of  the  forest  are  all  a  blur  to 
him,  and  he  knows  nothing  of  the  inspiration 
that  comes  therefrom.  He  can  see  and  deal 
with  the  minutest  m-^chanism  of  a  watch  and 
delight  in  it,  but  finds  no  pleasure  in  architec- 
ture ;  he  becomes  a  man  of  details  and  in- 
tricacies at  the  expense  of  unity  and  compre- 
hensiveness. He  also  judges  men  by  their  in- 
tentions at  quite  a  disadvantage  and  forms 
wrong  opinions  of  character.  Our  English 
language — all  language — is  so  constructed  as  to 
be  susceptible  of  ten  times  of  opposite  meanings 
by  a  few  changes  in  the  lines  of  countenance. 
Hence,  across  the  table,  or  in  a  room  he  loses  the 
ever- varying  shades  of  expression  that  come 
most  directly  from  the  heart,  and  trusts  to  the 
ear  by  which  he  is  often  misguided. 

Now,  all  this  must  have  its  efiect  upon  the 
general  disposition,  upon  the  character,  and  the 
health,  and  though  it  may  not  afiect  to  such 
an  extent  every  degree  of  myope  yet  the 
majority,  I  am  satisfied,  of  those  who  remain 
uncorrected,  suffer  more  or  less  of  these  dis- 
abilities. 

There  are  other  optical  defects  such  as  hyper- 
metropia  and  astigmatism  which  affect  the  in- 
dividual's comfort,  his  health,  mental  attain- 
ments, and  character  quite  as  much,  and  on 
these  it  might  be  of  interest  to  dwell  as  they 


286 


CANADIAN  JOURNAL 


affect  the  manhood  in  an  entirely  different 
way,  but  I  will  not  prolong  my  paper.  Enough 
has  been  said  to  show  the  gravity  of  abnormal 
vision.  The  attention  it  should  command  fi-om 
both  teachers  and  parents  and  the  importance 
of  submitting  every  child  to  a  careful  examina- 
tion of  his  optical  condition  before  urging 
him  into  a  long  educational  career ;  not  only  to 
see  whether  he  is  capable  of  pursuing  such  a 
course  without  danger,  but  to  see  that  he  is 
supplied  with  properly-fitting  spectacles  which, 
ha|)|)ily  for  either  the  myopic,  the  hyper-metro 
pic,  or  the  astigmatic  may  now  be  so  given  as 
to  reduce  the  eye  by  their  help  to  the  condition 
of  afar-seeing  eye,  and  thus  ])ermitthe  individual 
to  cultivate  the  same  tastes  and  pursue  the 
same  occupations  as  if  the  eye  was  naturally  a 
normal  eye. 

And  finally,  Mr.  President,  as  you  and  your 
confreres  are  taking  such  an  interest  in  your 
duties  on  the  Board  of  Health  for  Ontario,  and 
your  labours  which  will  be  of  inestimable  value 
for  the  public  weal,  are  to  be  expended  largely 
in  discovering  and  applying  the  valuable  ounces 
of  prevention,  I  may  be  permitted  to  enter- 
tain the  hope  that  the  question  that  I  have  but 
briefly  brought  before  you  may  not  be  deemed 
unworthy  your  consideration,  and  that  the 
hygiene  of  our  schools,  which  is  at  the  very 
foundation  of  future  society,  may  receive  that 
attention  which  it  so  much  demands,  and  which 
our  science  is  so  eminently  calculated  to  bestow, 

BI-MONTHLY   NOTES  ON  THERAPEU- 
TICS AND  PHARMACOLOGY. 

BY  R.   L.  MACDONELL,    B.A.,  M.D.,  M.R.C.S.,  ENG. 

(Assistant  Demonstrator  of  Anatomy,   McGill  Univer- 
sity, Montreal,  Physician  to  Montreal  Dispensary.) 

There  is  no  doubt  but  that  the  British  Phar- 
macopseia  requires  revision.  Of  the  remedies 
composing  it,  at  least  two  out  of  three  may 
safely  be  dropped.  The  principal  change  must 
be  the  alteration  of  the  doses.  Few  of  us 
prescribe  the  quantities  therein  directed.  Most 
writers  too,  on  therapeutics  limit  the  practi- 
tioner to  doses  wholly  insufficient  to  influence 
the  disease.  This  is  especially  true  of  chorea, 
of  syphilis  of  the  tertiary  kind,  and  of  certain 
Neuralgias.       A  great  deal  of  the  success  of 


specialists  is  due  to  the  careful  administration 
of  maximum  doses  of  remedies  known  to  be  of 
benefit  in  the  disease  under  treatment.  An 
instructive  essay  on  this  subject  was  read  by 
Dr.  Seguin  before  the  Medical  Society  of  the 
State  of  New  York,  Feb.  7th,  1882.  Teachers 
of  materia  medica  and  therapeutics  are  prone 
te  teach  dosage  on  the  "  in  medio  tutissimus 
ibis  "  principle,  with  an  eye  to  the  safe  training 
of  students.  The  druggists  too,  exert  a  bane- 
ful influence  by  supplying  the  practitioner  with 
ready-made  compounds,  pills  and  elixirs,  so 
that  many,  instead  of  adapting  the  mixture  to 
the  patient,  reverse  the  process,  and  adapt  the 
patient  to  the  mixture.  In  first  prescribing  a 
potent  remedy,  take  into  consideration,  age, 
sex,  size,  and  general  condition  of  the  patient. 
More  especially  note  the  condition  of  the  circu- 
latory organs.  Begin  with  "book  doses." 
Feel  your  way  "  fearlessly  because  watchfully." 
Amongst  the  remedies  Dr.  Seguin  mentions 
are  the  following  :  Extractum  conii  fructiisjlui- 
dum,  Wood  (Therapeutics,  1880,  p.  371)  puts 
the  dose  at  n^^i.,  Tl^ii. ;  Bartholow.  (Materia 
Medica,  1880,  p,  409),  dose  TTl^ii.,  T[\y.,  11)^x1. 
Dr,  John  Harley  (The  Old  Vegetable  Neuro- 
tics, London,  1867)  gave  larger  doses,  using 
the  Succus  Conii.  He  obtained  definite  phy- 
siological and  therapeutical  results  in  doses  of 
two  drachms  to  one  ounce.  In  this  way  he 
obtained  the  paresis  of  the  third  nerve,  arms, 
and  legs,  which  is  the  characteristic  result  of 
conium  action  upon  the  spinal  cord.  Dr.  Se- 
guin uses  conium  in  spasm  of  paralyzed  limbs, 
in  general  irritability,  and  in  insomnia. 

When  the  indication  is  present  as  in  chorea, 
to  obtain  muscular  relaxation,  after  a  few  ten- 
tative doses  of  20  and  40  minims,  he  gives  at 
one  dose  60,  80,  or  even  100  minims.  These 
doses  cause  ptosis  and  sometimes  diplopia  and 
paresis  of  the  arms  and  legs.  He  does  not  re- 
peat the  dose  until  all  the  effects  have  passed 
off — in  from  12  to  24  hours.  A  case  of  adult 
chorea  of  14  years'  standing  is  cited,  which 
was  almost  perfectly  cured  by  a  teaspoonful  of 
Squibbs'  extract  of  conium  given  daily  for  a 
month  or  more.  Cases  of  insomnia  with  wake- 
fulness in  the  first  part  of  the  night,  more 
especially  those  with  fidgets  or  physical  rest- 
lessness, are  very  much  benefitted  by  conium. 


OF  MEDICAL  SCIENCE. 


287 


Dr.  Seguin  usually  gives  20  minims  with  20 
grains  of  bromide  of  sodium  in  camphor  water, 
at  bedtime,  to  be  repeated  if  necessary.  In 
some  cases  (male  adults)  he  gives  50  or  60 
minims  at  one  dose  in  the  mixture,  not  to  be 
repeated.  Such  a  draught  has  been  often  re- 
turned to  him  by  druggists,  because  they 
thought  the  dose  enormous.  "  To  be  success- 
ful we  must  be  bold,  as  bold  as  physiological 
knowledge  can  make  us,  and  yet  as  cautious  in 
the  first  giving  of  powerful  drugs  to  a  patient 
as  if  we  had  no  courage  at  all." 

Iodoform  as  a  Wound  Dressing. — There 
are  many  advantages  in  the  use  of  this  pow- 
dep.  The  necessary  dressings  can  be  carried 
about,  can  be  applied  with  little  trouble,  and 
left  in  situ  a  considerable  period.  It  is  un- 
doubtedly the  best  dressing  for  the  country 
surgeon,  and  for  this  last  reason  I  think  it  wise 
to  devote  some  space  to  its  consideration. 

In  whatever  way  applied,  in  powder  or  solu- 
tion it  acts  as  a  local  disinfectant,  and  promotes 
a  healthy  action  in  the  healing  of  wounds. 

Its  use  has  been  overdone,  of  course.  There 
is  a  class  of  surgeons  who  overdo  everything. 
Chai'ges  of  producing  serious  symptoms  are 
brought  against  it.  But  are  its  toxic  effects  as 
often  seen  as  those  of  carbolic  acid  ?  Three 
surgeon?,  in  the  German  medical  journals,  have 
set  forth  their  experiences.  Schede  of  Ham- 
burg (Deutsche  Med.  Zeit.,  Feb.  2,  1882)  has 
seen  bad  effects.  Severe  attacks  of  poisoning 
set  in,  in  those  who,  by  idiosyncrasy  are  subject 
to  its  noxious  effects.  Death,  without  any 
warning,  may  occur,  even  though  the  adminis- 
tration be  immediately  suspended.  The  symp- 
toms jjroduced  are  mainly  as  follows  :  Pyrexia 
(104  F.);  depression  of  spirits,  headache, 
anorexia,  rapid  small  compressible  pulse. 
Stopping  the  drug  gives  relief  to  these  symp- 
toms. A  worse  stage  exists,  in  which  the 
pulse  rises  to  150  or  180  or  more  with  high 
fever,  and  in  this  condition  the  suspension  of 
administration  is  not  followed  by  reaction,  and 
death  follows.  Schede  also  mentions  certain 
forms  of  cerebral  disturbance  which  either  take 
the  form  of  acute  meningitis  or  of  a  psycho- 
logical disease  (melancholia,  etc.)  and  lead  to 
a  fatal  termination.  No  mention  is  made, 
however,  of  the  quantity  of  iodoform  used,  or 


the  size  of  the  wounds  to  which  it  was  applied. 
Singularly  enough,  no  post  mortem  records  are 
given. 

busier  ( Berliner  Klin  Wochenshrift,  No.  14, 
1882)  describes  somewhat  similar  results  from 
its  overdoses.  He  has  obtained  astonishing 
successes  with  iodoform  in  checking  decomposi- 
tion, and  in  the  treatment  of  tubercular  dis- 
eases, against  which  carbolic  acid  was  powerless, 
and  he  is  of  the  decided  opinion  that  resections 
are  now  much  more  successful  in  his  clinic 
than  formerly. 

Mundy,  of  Vienna,  in  the  same  periodical, 
looks  upon  iodoform  as  the  best  form  of  dress- 
ing for  the  battle  field.  It  requires  no  water  to 
make  solutions,  nor  clean  vessels,  and  can  be 
immediately  applied  in  the  first  and  second 
lines,  where  vessels  and  water  are  scarce  and 
there  is  no  time  for  circumstantial  dressing. 

Iodoform  is  applied  in  far  too  great  a  quan- 
tity to  large  surfaces  (80  to  300  grammes  at 
once  !)  On  minutely  examining  the  fatal  cases 
of  Mikulicz,  Schede,  Konig,  Hoeftman,  and 
Czerny,  it  was  found  that  the  post  mortem 
records  s^  ere  not  satisfactory  and  that  many  of 
the  victims  were  anaemic,  either  very  young  or 
very  old,  subjects  of  old  standing  suppuration, 
or  of  organic  disease.  A  small  quantity  of 
the  powder  should  be  dusted  into  the  wound, 
and  it  shoiild  be  removed  only  when  absolutely 
necessary.  Iodoform  is  a  drug  to  be  very 
carefully  handled,  taking  into  consideration 
that  it  contains  96  per  cent,  of  nascent  iodine. 

Parsley  as  an  Antilactic. — Dr.  Stanis- 
las Martin  states  that  as  an  external  appli- 
cation, parsley  acts  most  efficaciously  in 
dispersing  the  milk,  and  that  the  Roman 
nations  used  it  for  this  purpose.  The  breasts 
should  be  covered  with  freshly-plucked  leaves, 
and  these  should  be  renewed  several  times  a 
day  as  fast  as  they  begin  to  fade.  Dr.  Dujardin- 
Beaumetz  confirms  Dr.  Martin's  statement,  and 
addf.  that  in  Asia  Minor  a  cataplasm  of  parsley 
is  used  by  the  women  as  an  ordinary  domestic 
remedy,  [Bulletin  de  Therapy).  Parsley  is 
mentioned  by  Quincy  in  his  "  Compleat  English 
Dispensatory,  London,  1749,"  as  being  used  by 
the  common  people  "  in  cataplasms,  to  discuss 
and  resolve,  which  by  its  penetrating  nitrous 
salt  it  is  frequently  successful  in  doing." 


288 


CANADIAN  JOURNAL 


Nicolas  Culpepper  in  his  "  London  Dispen- 
satory," 1655,  describes  parsley  as  a  useful  poul- 
tice for  swollen  eyes,  "doth  much  help  thera, 
if  it  be  used  with  bread  or  meal  ;  and  being 
fryed  with  butter  and  applied  to  women's 
breasts  that  are  hard  through  the  curdling  of 
their  milk,  it  abateth  the  hardness  quickly, 
and  also  it  taketh  away  black  and  blue  marks 
coming  of  bruises  or  falls." 

Phosphorus  and  Phosphide  of  Zinc. — The 
author  uses  the  solution  of  phosphorus  of  Dr. 
Thompson,  of  which  the  following  is  the  latest 
formula :  R.  Phosphorus,  one  grain ;  Abso- 
lute Alcohol,  five  drachms  (dissolve  with  heat); 
Glycerine,  twelve  drachms;  Alcohol,  two 
drachms ;  Essence  of  peppermint,  two  scruples. 
Mix  the  two  solutions,  which  make  nearly 
twenty  drachms — 5j  =  1-20  gr.  This  should  be 
given  without  water. 

Dr.  Seguin  has  used  this  solution  with  the 
greatest  success  in  trigeminal  neuralgia,  and 
with  some  success  in  other  neuralgias.  He 
administers  one  teaspoonful  (about  1-18  gr.,  if 
we  estimate  a  teaspoonful  to  be  a  little  over 
one  drachm)  every  3  or  4  hours.  He  has 
known  a  case  of  severe  facial  neuralgia  (not 
chronic  epileptiform  neuralgia)  cured  in  two 
days,  and  even  in  24  hours.  This  solution  of 
phosphorus  has  given  satisfaction  in  conditions 
of  nervous  prostration,  cerebral  anaemia,  inci- 
pient cortical  degenei-ation  (dementia),  and  in 
melancholia.  It  should  be  combined  with 
cod  liver  oil  in  the  proportions  of  1:6  or  1:4,  a 
tablespoonful  of  the  mixture  being  given  after 
each  meal.  Oi-,  the  following  mixture  may  be 
extemporaneously  compounded,  and  given  two 
or  three  times  a  day  :  Thompson's  solution,  1 
teaspoonful;  sherry,  2  tablespoonfuls ;  cod 
liver  oil,  from  1  to  2  tablespoonfuls ;  and  the 
yolk  of  one  egg,  thoroughly  beaten  and  mixed, 
with  the  addition  of  a  little  oil  of  peppermint. 
This  is  well  received  by  most  patients,  and 
constitutes  a  most  valuable  tonic. 

In  the  treatment  of  posterior  spinal  sclerosis, 
cerebral  anaemia,  nervous  prostration  ("neuras- 
thenia "),  and  of  incipient  dementia,  the  phos- 
phide of  zinc  in  doses  of  ^  to  ^  gr.,  combined 
with  nux  vomica  or  with  belladonna,  according 
to  indication,  has  seemed  of  some  efficacy. 

Crystallized  Nitrate  of  Silver. — Dr.    Seguin 


has  used  nitrate  of  silver  in  locomotor  ataxy, 
and  is  disposed  to  agree  with  Erb  that  "  among 
the  internal  remedies  for  tabes,  nitrate  of 
silver  undoubtedly  stands  first,  as  it  can  show 
quite  undoubted  results."  The  course  of  the 
disease  has  been  checked  "  in  quite  a  number" 
of  .his  cases,  and  in  many  others  repeated 
periods  of  relief  were  secured.  It  is  seldom 
prescribed  in  doses  of  less  than  \  grain,  and 
usually  I  gr.  in  pill  with  extract  of  taraxacum 
or  with  extract  of  nux  vomica.  It  should  be 
given  before  meals  three  times  a  day,  and  often 
at  bedtime.  A  course  of  silver  usually  lasts 
two  months.  After  an  interval  of  two  or 
three  months,  another  shorter  course  is  given. 
None  of  his  patients  have  shown  any  skin  dis- 
colorations,  and  gastric  irritation  has  seldom 
occurred;  albuminuria  never.  This  paper  would 
be  of  far  greater  benefit  to  the  general  practi- 
tioner had  the  author  been  more  precise  in  the 
statement  of  his  results.  It  will  be  observed 
that  in  all  these  no  figures  are  used.  It  would 
be  more  satisfactory  to  know  the  number  of 
cases,  for  instance,  in  which  the  large  doses  of 
phosphorus  were  found  to  arrest  trigeminal 
neuralgia,  and  how  many,  times  it  was  given 
without  satisfactory  result.  In  how  many  cases 
of  tabes  dorsalis  was  the  silver  treatment  of 
benefit  ?     The  account  given  is  vague. 


VENESECTION  —  FOR  CONVULSIONS 
OCCURRING  DURING  SCARLATINAL 
DROPSY. 

BY    R.    A.    ALEXANDER,    M.D.,    GRIMSBY. 

Read  before  Ontario  Medical  Association,  June,  1882. 

On  the  2l8t  September,  1879,  C.  P ,  a 

boy  eight  years  old,  was  attacked  by  scarlet 
fever  which  ran  a  severe  couise,  and  was  fol- 
lowed in  the  first  week  of  January,  1880,  by 
general  dropsy.  Hydragogue  purgatives,  vapor 
and  hot  air  baths  were  used.  Urine  dimin- 
ished to  one  or  two  ounces  in  twentj-four  hours. 
Had  twitching  in  arms  and  legs.  Leeches 
over  kidneys,  with  subsequent  application  of 
cupping  glasses,  followed  by  warm  poultices, 
did  not  relieve  symptoms.  Bled  from  arm  to 
amount  of  four  to  six  ounces.  Rapid  recovery 
from    symptoms    of     convulsions    and    urine 


OF  MEDICAL  SCIENCE. 


289 


secreted  freely.  A  certain  amount  of  ascites 
and  albuminous  urine  continued  for  six  months. 
He  at  the  present  date  enjoys  very  good 
health. 

II.  A  girl,  twelve  jears  of  age,  had  a 
moderately  severe  attack  of  scarlet  fever  in 
December  last.  Two  weeks  after  disappear- 
ance of  rash,  face  and  body  began  to  swell. 
Urine  scanty  and  smoky.  Prescribed  infus. 
digitalis.  At  end  of  four  days  patient  much 
worse.  Violent  headache  and  unable  to  retain 
either  food  or  medicine.  Was  given  vapoi 
baths  and  pui'gatives.  Had  a  violent  c  )nvu'- 
sion  lasting  half  an  hour,  at  the  end  of  wl.icli 
she  remained  quite  unconscious.  In  less  than 
an  hour  another  convulsion  came  on,  and  when 
I  first  saw  her  had  lasted  for  an  hour.  Her 
face  was  livid,  pupils  contracted  to  a  small 
point,  frothing  at  mouth.  Bled  her  from  the 
arm  to  amount  of  eight  ounces.  The  convul- 
sion passed  off.  Was  able  to  swallow  a  dose 
of  chloral  and  potassium  bromide.  Slept  four 
hours.  Awoke  quite  sensible.  Made  a  rapid 
recovery. 


TRACHELORRHAPHY. 

BY  T.   K.  HOLMES,  M.D.,  CHATHAM. 

(Read  before  Ontario  Medical  Association,  June,  1882.) 

Emmet's  operation  for  the  cure  of  laceration 
of  the  cervix  uteri  is  on  its  trial  before  the 
medical  profession  at  present,  and  it  is  desirable 
that  its  utility  be  correctly  estimated. 

In  the  hope  of  eliciting  a  discussion  of  the 
subject  I  present  this  paper,  and  by  omitting 
as  far  as  possible  all  points  discussed  in  gyne- 
cological works  and  which  are  either  familiar 
to  or  within  reach  of  every  one,  I  hope  to 
limit  it  to  a  very  few  pages.  In  my  experience 
laceration  is  found  in  forty  per  cent,  of  all 
uterine  affections  and  is  seldom  uncomplicated, 
usually  co-existing  with  areolar  hyperplasia, 
subinvolution,  endocervicitis  or  some  form 
of  displacement. 

The  predisposing  causes  are  : — 

Ist.  Rigidity  of  cervix. 

2nd.  An  unhealthy  state  of  cervical  tissue. 

3rd.  Abnormal  presentations. 


4th.  Disproportionate  size  of  fcetal  head. 

The  proximate  causes  are  : — 

1st.  "Violence  of  uterine  contractions. 

2nd,  Maternal  efforts  at  expulsion  when  the 
head  is  about  to  escape  from  the  os. 

3rd.  Artificial  delivery  unskilfully  per- 
formed. The  operation  of  the  first-named 
exciting  cause  is  often  due  to  the  injudicious 
administration  of  oxytocics,  more  particularly 
ergot.  There  are  doubtless  other  causes  but 
r.liese  are  the  chief  ones.  Lacerations  may  be 
ilivided  into  those  that  heal  spontaneously 
and  those  that  do  not,  and  the  latter  into 
those  that  can  be  cured  by  topical  applica- 
tions and  those  that  can  only  be  cured  by 
traclulorrhaphy. 

Slight  lacerations  of  recent  origin  get  well 
quickly  under  the  use  of  the  hot  douche, 
medicated  tampons,  local  depletion,  and  stimu- 
lating applications  of  iodine,  carbolic  acid,  &c. 
Nitrate  of  silver,  if  usfd  at  all,  must  be  applied 
with  the  utmost  cauti'm  as  it  is  otherwise  sure 
to  produce  contraction  which  may  result  in 
stenosis. 

The  gravity  of  the  symptoms  does  not  bear  a 
direct  relation  to  the  extent  of  the  laceration, 
but  depends  upon  the  condition  of  the  whole 
organ,  and  of  the  pathological  state  of  the  torn 
partP. 

Subinvolution,  metritis,  follicular  enlarge- 
ment, and  displacements  augmenting  the 
suffering  while  without  any  of  these  the  sensi- 
tive state  of  the  torn  cervix  is  alone  sufiicient 
to  greatly  impair  the  health  and  render  medi- 
cinal treatment  useless.  Having  had  his  at- 
tention directed  to  the  uterus  as  the  organ  dis- 
eased in  a  given  case,  and  having  on  examina- 
tion found  a  laceration,  how  is  the  physician  to 
determine  as  to  the  advisability  or  necessity  of 
an  operation  ]  This  is  an  important  question 
and  requires  considerable  experience  to  answer 
it  correctly.  If  the  cervical  tissue  is  soft  and 
the  laceration  small  with  little  or  no  ever- 
.sion  of  the  lips,  and  there  is  reason  to  believe 
the  injury  to  be  of  recent  origin,  the  case  is 
one  offering  a  good  prospect  of  perfect  cure 
by  topical  applications.  Oa  the  other  hand, 
if  the  laceration  ba  extensive,  the  eversion 
marked  or  the  tissue  hard  and  of  a  cicatri- 
cial character  an  operation  is  imperative,  be- 


290 


CANADIAN  JOURNAL 


cause  even  if  we  succeed  in  accomplishing  a 
healing  of  the  raw  granular-looking  surface 
by  other  means,  the  eversion  will  not  be  cured 
and  the  harJ.  whitish  oic.itricial  cervix  will 
remain  and  give  rise  to  symptoms  of  malnutri- 
tion and  nervous  disturbance  almost  or  quite 
as  serious  as  obtained  before.  Laceration 
generally  permits  eversion  of  the  lips,  and  when 
it  does  an  accurate  idea  of  its  extent  may  be 
obtained  by  hooking  a  tenaculum  into  each 
of  the  everted  lips,  and  drawing  them  togther. 
When  this  is  done  the  raw  surface  diminishes 
as  the  inversion  is  accomplished  until  it  nearly 
or  wholly  disappears.  Sometimes  little  or 
no  eversion  exists  until  upward  pressure  on 
the  vaginal  walls  at  the  cervical  attachment 
pulls  the  torn  lips  apart  and  discloses  the 
chai*acteristic  raw  surface.  This  can  be  accom- 
plished by  using  a  large  Ferguson's  speculum 
and  pushing  it  well  up  so  as  to  make  the 
desired  upward  pressure  on  the  vaginal  walls. 
The  same  may  be  done  by  using  a  Sim's 
speculum. 

The  various  kinds  of  laceration  are  so  fully 
described  in  works  on  the  subject  as  to 
obviate  the  necessity  of  speaking  of  that  part 
of  the  subject  here. 

Immediate  operation,  or  that  at  the  time  of 
the  injury  I  have  not  performed.  Dr.  Munde, 
editor  of  the  American  Journal  of  Obstetrics, 
strongly  recommends  it,  and  judging  from  his 
results  it  is  worthy  of  consideration  and  if 
union  be  secured  would  doubtless  lessen  the 
chances  of  septicaemia,  just  as  immediate  closure 
of  lacerated  perineum  does.  If  not  sewed  up 
immediately  it  is  necessary  for  involution  to  be 
completed  before  operating.  Pelvic  cellulitis, 
or  indeed  acute  inflammation  of  any  of  the 
pelvic  organs,  contra-indicates  an  operation  and 
should  be  overcome  before  attempting  one.  In 
all  cases  operated  on  by  me  I  have  resorted 
to  a  preparatory  treatment  consisting  of  the 
hot  douche,  tampons  saturated  with  glyce- 
rine and  tannin,  local  depletion,  and  in  cases 
complicated  with  displacement  daily  reposi- 
tions by  postural  method,  aided  by  gentle 
pressure  per  vaginam  and  maintained  by  small 
medicated  dossils  of  cotton  batting.  The  use 
of  the  hot  douche  immediately  before  operating 
renders  hsemorrhage  less  troublesome.     I  have 


found  the  following  the  most  convenient  and 
satisfactory  method  of  operating.  The  patient 
properly  etherized  is  placed  on  a  table  of 
convenient  height  in  the  lithotomy  position 
and  before  a  clear  but  not  dazzling  light.  One 
assistant  administers  ether  while  two  othei's 
support  the  knees  and  feet  keeping  the  thighs 
well  flexed.  One  of  these  assistants  also  holds 
a  Sim's  speculum  under  the  pubic  arch,  while 
the  other,  if  necessary,  uses  the  sponge. 

The  instruments  required  are  a  small  vulsel- 
lum  forceps,  a  long  bistoury,  scissors  curved  on 
the  flat,  sponge  holders,  needle  forceps,  wire 
twisting  forceps,  shield  for  limiting  the  twist- 
ing of  the  wires,  two  Emmet's  needles  threaded 
with  silk  and  half-a-dozen  No.  28  best  silver 
sutures,  sixteen  inches  long. 

Having  with  the  left  hand  seized  the  pos- 
terior lip  of  the  cervix  with  the  vulsellum 
forceps  so  as  to  have  the  upper  jaw  occupy 
the  part  that  is  to  form  the  restored  cervical 
canal  the  operator  steadies  the  uterus  and 
with  a  long  bistoury  divides  the  tissue  on 
each  side  of  the  upper  jaw  of  the  forceps, 
fii'st  on  the  posterior  lip  then  on  correspond- 
ing parts  of  the  anterior  lip  leaving  a  strip 
nearly  half  an  inch  wide  in  the  centre  where 
the  forceps  hold  untouched  and  which  are 
being  brought  into  apposition  from  the  con- 
tinuation of  the  cervical  canal.  The  removal 
of  the  tissue  can  be  performed  with  great 
facility  with  the  bistoury  and  in  much  less 
time  than  can  be  done  with  scissors,  besides 
the  internal  boundary  of  the  denuded  surface 
can  be  more  easily  and  accurately  made  with 
the  knife.  Care  must  be  taken  to  remove  all 
cicatricial  tissue. 

After  bleeding  has  been  stopped  the  wires 
are  to  be  passed  in  the  manner  described  by 
Emmet ;  the  wires  twisted  and  sheathed  in  a 
piece  of  rubber  drainage  tubing.  Absolute 
rest  in  bed  is  necessary  in  some  but  not  in 
all  cases,  the  condition  of  the  patient  being 
the  criterion.  Union  is  often  perfect  in  seven 
days,  but  as  no  harm  results  from  the  presence 
of  the  silver  sutures  they  may  be  left  in  ten  or 
twelve  days  if  union  be  not  complete  before 
that  time. 

The  following  table  gives  a  short  statement 
of  nine  cases  upon  which  I  have  operated. 


OF  MEDICAL  SCIENCE. 


291 


02 

m 
03 

.a 

o 
o 

o 

Steadily  improved,  and  became 
pregnant  in  six  months  after  opera- 
tion.     Was  delivered  at  full  term, 
and  is  now  perfectly  well. 

03 

13 

O 
+-> 

& 

n3 

03 

a 
•3 
S 

03 
U 

w 

Became  pregnant,   and  was  de- 
livered without  injury  to  cervix. 
Wears  a  retroversion  pessary,  and 
is  much  better. 

^-> 

"a 
o 

Q 

-s 

a 
oa 
a 

8 

a 

o 

03 

"si 

03  a 

03    CD 

O)     03 

S  > 

Able  to  perform  domestic  duties 
pretty  well.    Not  perfect  recovery, 
but  greatly  improved. 

Is  wearing  a  retroversion  pessary. 
Not  improving  very  fast.     Is  very 
hysterical. 

Two  weeks  after  operation  walked 
two  miles  without  fatigue.  Is  greatly 
improved. 

03 

o 

§ 

o 

Ha 

00 

*i  2 

§  3 

'a  a 

Date  of 
Opera- 
tion, 

goo 

a 

b'= 

bo 

3  00 

03  «D 

goo 

P^  — < 

Oi 

03  00 

goo 

.00 
>00 
O  T-H 

■-',-H 

t».oo 

m 
"^ 
O 

02 
O 

1— 1 
ft 

1 

as 

cu  a 

l« 

<I> 

.2 

a 

%\ 

\^    O 

1  i 

S-Sb 

a^l 

.2  5| 

•It's 
113 

O 

.2  §2 

§  ^-^ 
111 

08 

to 

.s 

M 
'3 

_a 

•  >'^- 

.2;!^b' 
SgS 

a  ra  03 
<Jftfi 

o 

&: 

o 

>i  el 

.-H      4) 

2  f^ 

"  a 
S'S.2 

M  ^^ 

r-H     fl     03 

-2  aQ 

08    «J    S    >» 

a  M)8.ti 
,2<5,S 

.2 
-a 

13 
a) 

^  a 
O  2 

COMPLICATIONS. 

•i 

-i 

o 
Ph 
>^ 

W 

'o 

03 

a 

03 

a 
o 

;zi 

a' 

o 

03 

<c 

o 

03 

a 
o 

tz5 

S 

.^-      i 
a  B     -c 
^  a     (1^ 

^    2    53  13 
^    P^  tl    08 

r^      O      M      S 

02PhO>^ 

a 

o 

■s 

03 
> 
O 

03 

a 
o 

03 

03 
P5 

03 

a 

03 

'a 
02 

03 

£ 

03 

a 
2 

m       03 

02     *^ 
CO 

1 

-i 

03 
02 

1 

3 

2 

03 

2 

Duration 

of 

Laceration. 

CD 

3 

03 

1 

>> 

CO 

00 

03 
>> 

03 

CO 

i 

03 

2 

T-l 

2 

08 
03 
>> 
CO 

^3 

a 

<1 

a 
o  o 

< 

1— ( 

HO 

a 

03.2 

CO 

rjt 

(N 

(N 

03 

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(M 

CO 

CO 

00 

eo 

CO 

CO 

S 

od 

!zi 

1-3 

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2 

f4 

02' 

1^ 

p4 
2 

1^ 

e 

02* 

CO 

O    08 

H^ 

M 

1—5 

1— 1 

>■* 

1-5 

> 

d 

292 


CANADIAN  JOURNAL 


HEART   DISEASE    IN    CONNECTION 
WITH   ACUTE   RHEUMATISM. 

BY    J.   FERGUSON,    B.A.,    M.D.,    L,R.C.P.,    ASSISTANT 

DEMONSTKATOR    OF  ANATOMY,  TORONTO 

SCHOOL   OF   MEDICINE. 

Many  physicians  must  have  noticed  the  heart 
complications  occumng  during  an  attack  of 
acute  rheumatism,  or  following  it  at  some  con- 
siderable time.  From  careful  examination  into 
the  fa^ts  of  such  cases,  it  appears  that  this  ad- 
ditional and  serious  factor  occurs  most  fre- 
quently in  the  young,  and  of  these  in  girls 
oftener  than  in  boys.  It  has,  I  fear,  been  too 
generally  held  as  an  axiom  in  medicine,  that 
these  cases  are  incurable,  and  that  the  patient 
must  progress  from  bad  to  worse,  till  he  perishes 
of  a  hopelessly  disorganized  heart,  or  succumbs 
to  some  intei-current  affection  that  the  debilitated 
system  and  deranged  circulation  render  him 
amenable  to.  It  is  with  the  view  of  trying  to 
combat  this  opinion,  this  article  is  written. 

The  heart  is  a  powerful  muscular,  dilatation 
in  the  vascular  system,  with  contracting  power 
to  force  the  blood  in  any  direction  it  is  free  to 
flow.  In  the  state  of  health,  the  valves  prevent 
the  flow  backwards  ;  and  so  the  stream  must  go 
in  one  continuous  current  onwards.  This  state 
of  things  may  be  changed  in  various  ways. 
Some  of  these  are  not  curable,  though  they 
may  admit  of  a  certain  degree  of  amelioration. 
While  the  form  of  derangement  I  am  going  to 
discuss,  does  appear  both  from  theoretical  and 
practical  grounds,  to  be  of  the  class  that  admits 
of  successful  treatment. 

The  openings  in  the  heart  are  surrounded  by 
fibrous  rings,  and  to  these  rings  are  attached 
the  afferent  and  efferent  vessels,  the  valves  and 
the  muscular  structure  of  the  organ.  The 
valves  sit  upon,  and  are  supported  by  projecting 
shelves  of  this  fibrous  tissue,  rather  than  grow- 
ing out  of,  and  being  mere  re-duplications  of  the 
lining  membrane.  The  valves  in  addition  to 
hanging  from  the  surface,  are  supported  upon  a 
base,  and  it  is  this  base  that  gives  them  a  great 
d'-al  of  their  power  in  resisting  the  backward 
flow  of  the  blood. 

The  same  form  of  swelling  found  in  the 
fibrous  tissue  of  the  joints,  may  occur  in  these 
fibrous  rings  in  the  heart.     At  this  stage,  there 


is  simply  swelling  in  the  tissue,  but  no  organic 
change;  and  just  as  the  swelling  in  the  joints 
may  disappear,  so  may  the  swelling  in  the  fibrous 
structure  of  the  heart.  In  order  that  the 
valves  may  close  and  prevent  regurgitation,  the 
base  upon  which  the  valves  sit  requires  to  be 
in  a  normal  condition.  Now  when  this  part  of 
the  heart  is  swollen,  the  actual  size  of  the  open- 
ing is  lessened,  and  may  be  very  nearly  closed, 
so  that  there  is  the  condition  of  stenosis.  This 
is  not  the  most  important  element  of  the  dis- 
turbance however.  As  the  fibrous  rings  and 
the  bases  upon  which  the  valves  rest  become 
enlarged,  the  latter  are  tilted  in  the  opposite 
direction ;  and  if  it  be  the  auriculo-ventricular 
opening  that  is  affected,  the  valves  are  forcibly 
pushed  into  the  ventricle,  and  held  back  towards 
the  side  of  its  walls.  From  this  it  is  clear  that 
the  valves  do  not  fail  freely  back  so  as  to  close 
the  opening,  and  a  regurgitant  murmur  is  heard 
along  with  the  condition  of  stenosis  just  men- 
tioned. So  far  there  may  be  no  lesions,  no  de- 
posits or  fungoid  growths  on  the  valves,  rings, 
or  cords.  So  far  there  may  be  nothing  that  is 
incurable.  Simply  the  function  is  interfered 
with  from  a  swelling  of  the  parts. 

Now  on  theoretical  grounds,  if  we  can  remove 
this  swelling  before  any  growths  or  deposits 
take  place,  then  we  may  feel  assured  that  much 
good  has  been  accomplished.  The  chordae  ten- 
dineae  are  greatly  enlarged,  and  as  they  thicken, 
they  shorten.  This  fact  can  be  proven  on  the 
fresh  heart  in  various  ways,  which  I  purpose 
making  known  on  a  future  occasion.  When 
the  cords  are  thus  shortened,  there  is  a  second 
factor  in  the  prevention  of  the  closure  of  the 
valves. 

The  following  cases  may  bring* out  the  prin- 
cipal points  in  the  treatment  of  these  cases  : — 

Miss  G ,  aged   13  years,  a  patient  of  Dr. 

Clark's,  near  Newcastle,  England,  had  a  severe 
attack  of  acute  rheumatism  in  the  middle  of 
January,  1881.  About  the  third  week  of  her 
illness,  she  was  taken  with  heart  trouble.  The 
patient  was  under  my  care.  Along  with  Dr. 
Clark,  I  determined  to  put  her  to  bod,  and 
keep  her  there  for  months  if  needed.  Her  diet 
was  restricted  almost  entirely  to  milk.  All 
exertion  was  completely  interdicted.  A  mix- 
ture of  digitalis,  potassium  iodide,  and  salicylate 


OF  MEDICAL  SCIENCE. 


293 


of  soda  was  ordered,  and  each  of  these  ingred- 
ients pushed  as  far  as  the  patient  could  bear 
them.  At  the  end  of  six  weeks  all  murmurs 
had  ceased  ;  but  though  the  patient  was  allowed 
out  of  bed,  the  treatment  in  other  respects 
was  continued  for  about  two  months  longer. 
I  had  a  letter  from  the  young  lady  a  short  time 
ago,  stating  that  there  had  been  no  recurrence 
of  the  heart  trouble,  and  that  her  health  was 
all  that  could  be  desired. 

The  second  case,  Mary  K ,  from  my  own 

part  of  Ontario,  Huron,  was  brought  to  Toronto 
and  put  under  my  care.  There  was  certainly 
very  severe  cardiac  trouble,  a  good  deal  of 
dyspnoea,  a  scanty  amount  of  urine  secreted, 
the  limbs  cedematous,  and  the  abdomen  con- 
siderably distended.  The  patient  was  at  once 
ordered  to  bed,  and  put  on  a  milk  diet.  The 
same  mixture  of  potassium  iodide,  salicylate  of 
soda,  and  digitalis  prescribed.  To  aid  in  re- 
lieving the  dropsied  state  of  the  body,  an  incision 
was  made  over  each  internal  malleolus  about 
an  inch  in  length,  and  freely  through  the  sub- 
cutaneous tissue.  The  discharge  of  fluid  was 
very  free  for  the  first  three  days ;  but  by  the 
seventh,  nearly  all  trace  of  anasarca  had  disap- 
peared. The  recumbent  posture  was  maintained 
for  nearly  two  months,  and  she  left  the  city  in 
a  very  good  state  of  health,  and  with  the  merest 
trace  of  the  cardiac  murmur,  so  audible  at  the 
commencement.  She  is  still  taking  her  mix- 
ture, and  T  am  quite  confident  that  in  due  time 
the  disturbance  will  have  entirely  ceased. 

I  base  the  treatment  upon  the  following 
principles:  1st.  A  milk  diet,  because  it  is  nu- 
tritious and  leaves  little  residue  for  the  diges- 
tive system  to  get  rid  of;  while  it  favours  the 
action  of  the  kidneys.  2nd.  The  maintenance 
of  rest,  a  condition  that  secures  muscular  inac- 
tivity throughout  the  body,  and  gives  the  heart 
as  much  ease  as  possible.  This  is  very  neces- 
sary, just  as  in  the  treatment  of  any  inflamed 
organ.  3rd.  With  regard  to  the  medicinal 
treatment  I  need  say  nothing  further  than 
that  T  am  a  firm  believer  in  the  protracted  use 
of  some  preparation  of  salicylic  acid  after  an 
attack  of  rheumatism,  so  as  to  eliminate  from 
the  system  as  thoroughly  as  possible  the  ten- 
dency to  recurrence,  and  to  remove  any  com- 
plications that  may  have  taken  place. 


When  we  find  a  murmur  during  or  following 
an  attack  of  rheumatism,  I  hold  thai  it  is  im- 
possible to  say  whether  it  be  due  to  actual 
deposits  upon,  or  around  the  valves^  or  only  to 
swelling  and  thickening  of  these  parts.  It  is, 
therefore,  our  duty  to  follow  that  line  of  treat- 
ment which  will  remove  the  latter  condition, 
or  improve  the  former,  if  unfortunately  it  should 
exist,  and  thus  place  our  patient  in  as  favour- 
able a  condition  as  possible,  for  making  a  good 
recovery  in  the  least  time. 


REMOV'AL  OF  A  FIBROCYSTIC  TU- 
MOUR, OF  THE  UTERUS,  WEIGHING 
TWELYE  POUNDS. 

BY    DRS.    STEWART  AND    HURLBURT,  BRUCEFIELD. 

Miss  W.,  aged  eighteen,  when  first  seen  on  the 
first  of  last  June  complained  of  swelling  of  the 
abdomen.  She  first  noticed  that  she  was 
getting  larger  than  usual  a  little  more  than 
two  years  ago.  During  the  last  few  months 
there  has  been  a  steady  and  marked  increase 
in  the  size  of  the  abdomen  with  a  general  loss 
of  flesh  and  strength. 

She  always  enjoyed  good  health  previous  to 
her  present  trouble.  Family  history  is  good. 
The  catamenia  first  made  their  appearance 
three  years  ago,  and  continued  at  irregular 
intervals  until  five  months  ago,  since  which 
they  have  been  very  regular. 

The  abdominal  cavity  is  the  seat  of  a  large 
tumour  which  can  be  traced  into  the  pelvis.  It 
can  be  moved  in  all  directions.  It  has  a  semi- 
solid feel.  With  the  exception  of  a  small  line 
of  resonance  in  the  right  flank  the  whole 
abdomen  as  high  as  four  inches  above  the 
umbilicus  is  dull.  The  abdomen  is  unequally 
distended.  It  is  nearly  two  inches  further  from 
the  umbilicus  to  the  right  anterior  superior 
spine  of  the  ilium  than  it  is  between  the  corres- 
ponding points  on  the  left  side.  No  fluctuation 
can  be  detected  in  the  tumour,  neither  can  any 
free  fluid  be  made  out  in  the  abdominal  cavity. 
The  uterus  is  pushed  down  and  Douglas's 
pouch  is  obliterated.  The  uterus  is  normal  in 
size. 

There  is  slight  oedema  of  the  lower  extremi- 
ties. 

Nothing  abnormal  found  on  making  a  physi- 


294 


CANADIAN  JOURNAL 


cal  examination  of  the  chest.  The  urine  is 
normal  in  quantity,  colour,  reaction,  and  specific 
gravity.     It  is  free  from  albumen. 

She  has  suffered  considerably  during  the  last 
year  from  sharp  attacks  of  abdominal  pain. 

The  diagnosis  arriveil  at  was  a  muUilocular 
cyst  of  left  ovary. 

0})eration. — Present :  Drs.  Gillies,  McMick- 
ing,  Taylor,  Cas.sidy,  Tamblyn,  and  INIcDonagh. 
Dr.  McLean  administered  ether.  After  open- 
ing the  peritoneum  a  trocar  was  introduced 
into  what  was  still  considered  an  ovarian  cyst. 
The  fluid  coming  away  it  was  withdrawn.  This 
was  followed  by  copious  bleeding  from  the  seat 
of  the  puncture  which  was  partly  stopped  by 
plugging  the  cavity  with  the  fingers.  Rej)eated 
attempts  were  now  made  to  lessen  the  size 
of  the  tumour  by  tapping  it  in  various  places, 
but  without  any  success.  The  haemorrhage 
fi^cm  the  jmncture  being  still  considerable  and 
even  getting  alarming  we  quickly  extended  the 
incision  both  upwards  and  downwards.  It  was 
in  all  ten  inches  in  length,  from  the  pubes  to 
two  inches  above  the  umbilicus.  After  a  little 
manipulation  the  tumour  was  turned  out,  and 
the  pedicle  which  was  about  three  inches  in 
length  and  attached  to  the  upper  and  left 
border  of  the  uterus  was  secured  by  carbolized 
silk,  the  ends  cut  short  and  dropped  back.  The 
abdomen  was  now  carefully  sjwnged  out.  There 
was  a  good  deal  of  difficulty  in  doing  this  owing 
to  the  large  quantity  of  blood  that  escaped  from 
the  first  tapping  and  from  the  presence  of  the 
brain-like  contents  of  a  cyst  which  burst 
during  the  efibrts  at  extraction. 

The  abdominal  wound  was  then  closed.  A 
rubber  drainage  tube  of  large  size  was  left  in 
the  lower  part  of  the  wound. 

The  whole  operation  which  was  conducted 
with  the  strictest  antiseptic  precautions  occu- 
pied an  hour  and  three  quarters  in  its  perfor- 
mance. 

When  the  patient  was  removed  to  bed  her 
pulse  was  108,  two  hours  after  it  fell  to  100. 

■Vomiting  was  a  prolonged  and  troublesome 
symptom,  having  lasted  about  forty-eight  hours. 
The  hypodermic  injection  of  morphia  appeared 
to  have  more  influence  in  checking  it  than  any- 
thing else.  The  highest  recorded  temperature 
was  103°,  but  it  only  kept  at  this  height  for 


an  hour.  The  application  of  cold  to  the  head 
reducing  it  to  101*^. 

At  no  time  during  the  subsequent  history  of 
the  case  was  there  any  cause  for  alarm.  The 
drainage  tube  was  removed  at  the  end  of  the 
third  day.  During  the  first  twenty-four  liours 
there  was  at  least  a  pint  of  reddish 
serum  discharged.  The  wound,  except  where 
the  drainage  tube  wa.s,  was  healed  on  the  sixth 
day.  On  the  ninth  day  union  was  complete. 
The  patient  was  sitting  up  on  the  fourteenth 
day  and  walking  about  on  the  twentieth.  It 
is  now  seven  weeks  since  the  operation  and 
she  continues  in  the  best  of  health. 

Remarks. — The  error  in  diagnosis,  although 
it  was  of  no  real  practical  significance  might 
have  been  avoided  if  tapping  had  been  resorted 
to.  But  as  this  is  a  very  serious  procedure,  it 
is  best  to  operate  without  it,  even  if  the  diag- 
nosis is  not  certain. 


SOME  POINTS  REGARDING  MEA- 
SUREMENTS IN  SURGICAL 
PRACTICE. 

BY    WM.    OLDRIGHT,    M.A.,    M.D.,    TORONTO, 

Lecturer  on  Sanitary  Science,  Adjunct  Lecturer  on  Medi- 
cal Jurisprudence  and  Curator  of  Museum  in  the 
Toronto  Sclwol  of  Medicine,  Surgeon  to  News 
Boys'  Lodgings,  Chairman  of  Provincial 
Board  of  Health. 

Read  before  the  Ontario  Medical  Association,  June,  1882. 

Mr.  President  and  Gentlemen  of  the  Ontario 
Medical  Association, — My  principal  object  in 
this  brief  paper  will  be  to  point  out  a  common 
source  of  error  in  the  measurement  of  the 
lower  extremities,  especially  during  the  treat- 
ment of  fracture  of  the  femur. 

Before  doing  so,  however,  I  may  be  allowed 
to  ask  you  to  consider  the  question  of  the  value 
of  measurements  in  the  treatment  of  fractures 
and  dislocations. 

Most  of  the  members  of  this  Association  are 
aware  of  the  view  enunciated  by  Dr.  Sayre, 
(that  shortening  should  not  occur  with  proper 
surgical  treatment),  and  how  this  statement 
was  challenged  by  Prof.  Gross,  still  chafing 
under  the  remembrance  of  a  vexatious  and 
unjust  suit  for  malpractice,  and  also  how  it  has 
been  further  combatted  by  Dr.  Frank  Hamil- 
ton in  the  last  edition  of  his  work  on  "  Ei-ac- 


OF  MEDICAL  SCIENCE. 


295 


tures  and  Dislocations."  Amongst  other  argu- 
ments, Dr.  Hamilton  draws  attention  to  the 
fact  that  in  a  very  large  proportion  of  persons 
whose  legs  have  been  uninjured  one  is  longer 
than  the  other,  and  that  the  difi'erence  is  gen- 
erally in  favor  of  the  left.  Upon  this  fact 
some  practitioners  have  based  an  opinion  that 
there  is  no  use  in  measiirements,  I  have  heard 
one  very  well  read  and  skilful  gentleman,  a 
member  of  our  Association,  express  this  opin- 
ion. Now  I  think  it  a  pity  that  this  opinion 
should  prevail.  I  consider  that  in  the  mea- 
surement of  limbs  we  have,  to  say  the  very 
least,  what  may  prove  a  very  valuable  correc- 
tive in  many  cases.  And  on  again  looking  up 
Hamilton's  remarks,  I  see  that  he  expresses 
the  same  view,  and  thinks  that  if  we  abandon 
mcasui-ement  we  abandon  one  of  the  diagnostic 
means  which  has  led  to  such  vast  improve- 
ments in  the  treatment  of  fracture  of  the  femur. 

Believing  that  every  contribution,  however 
slight,  to  the  data  of  surgical  knowledge  may 
be  of  some  service,  I  measured  last  week  the 
legs  of  fourteen  boys  in  the  News-boys'  Lodg- 
ing. Of  these  I  found  only  two  deficient,  and 
in  one  I  could  only  discover  about  one-sixth  of 
an  inch  difierence,  and  in  the  other  the  dif- 
ference was  half  an  inch.  From  neither  could 
I  obtain  any  history  of  accident. 

I  believe  that  in  the  upper  extremities  greater 
differences  are  often  found  than  in  the  lower. 
I  have  myself  noticed  this  in  persons  who 
have  been  round-arm  bowlers  in  cricket  during 
boyhood  and  youth. 

The  eri-ors  in  measurement  to  which  I  have 
made  reference  occur  from  the  pelvis  being 
drawn  down  on  one  side,  and  the  legs  not  being 
placed  at  the  same  angle  to  the  outer  surface  of 
it.  If  we  look  at  the  skeleton  we  will  observe 
that  two  lines,  drawn  respectively  from  the 
anterior  superior  spinous  process  of  the  ilium 
to  the  hip  joint,  and  from  the  hip  joint  to  one 
of  the  malleoli  will  meet  at  an  obtuse  angle, 
and  if  we  now  abduct  the  whole  leg  we  shall 
find  that  the  angle  becomes  less  obtuse.  Hence 
by  a  well-known  geometrical  rule,  the  subtend- 
ing line  from  the  anterior  superior  spinous  pro- 
cess to  the  malleolus  will  be  greater  in  the 
former  than  in  the  latter  case.  This  will  be 
rendered  far  more  evident  if  we  continue  to  ab- 


duct the  leg  till  the  femur  is  brought  close  up  to 
the  spinous  process.  It  is,  of  course,  impossible 
to  get  that  degree  of  abduction  in  ordinaiy  liv- 
ing men,  but  this  exaggerated  form  illustrates 
very  forcibly  to  the  eye  what  takes  place  to  a 
less  extent  in  life. 

Now  this  tilting  down  of  the  pelvis  on  the 
affected  side  is  what  actually  takes  place  in 
practice  when  traction  is  made  by  the  weight 
and  pulley,  especially  in  young  persons,  the 
flexible  lumbar  spine  on  which  the  pelvis  is 
hinged  allowing  it  to  be  deflected  from  the 
right  angle  which  they  usually  make  with  each 
other. 

I  was  very  much  struck  with  this  in  treating 
a  boy  some  twelve  years  ago.  I  had  shorten- 
ing as  T  supposed — more  than  half  an  inch — 
and  I  added  pound  after  pound  to  the  heavy 
weight  already  on,  and  continued  to  do  this  for 
three  or  four  days ;  and  without  improving  the 
length  of  the  linob,  I  added  very  much  to  his 
discomfort.  At  last  I  began  to  be  suspicious 
of  the  reason,  and  I  made  a  paste-board  square 
of  the  ~P  form,  which  I  now  produce.  I  ap- 
plied the  ends  of  the  horizonal  portion  of  the 
"P  to  the  spinous  processes  of  the  ilium, 
and  found  that  the  leg  was  abducted  to  a 
marked  degree.  I  now  drew  the  other  leg  out 
to  the  same  angle,  and  on  measuring  could  not 
discover  that  the  affected  limb  was  in  the 
slightest  degree  shorter  than  the  other.  I  took 
off  the  excess  of  my  weights  gradually  and  got 
a  good  result. 

Some  time  afterwards  I  happened  to  mention 
the  matter  to  Dr.  Aikins,  and  found  that  he 
had  passed  through  a  similar  experience.  I  do 
not  mean  to  say  that  he  was  as  long  discover- 
ing his  error. 

I  have  no  doubt  that  many  here  have  no 
ticed  similar  facts,  but  as  I  have  never  seen 
the  matter  referred  to  in  print,  I  have  thought 
it  well  to  di-aw  attention  to  it. 

The  upper  arm  of  the  square  is  made  of 
paste-board  or  other  flexible  material,  so  as  to 
allow  of  its  being  bent  down  over  the  abdomen 
on  to  the  spinous  processes. 

The  same  error  would  occur  if  the  one  limb 
were  more  flexed  towards  the  abdomen  than 
the  other ;  but  the  malposition  is  less  likely  to 
be  overlooked. 


•296 


CANADIAN  JOURNAL 


I  have  not  adverted  to  such  modes  of  mea- 
surement as  taking  the  symphysis  pubis  as  one 
of  the  points,  as  I  hope  this  mischievous 
method  is  not  in  vogue  with  any  person  in  this 
room.  I  use  the  word  "  mischievous "  in  re- 
membrance of  some  curious  results  in  Court 
that  have  been  connected  with  this  mode  of 
measurement. 


HOSPITAL  NOTES. 

BY  MR,  FRANK  KRAUSS. 

SCIATIC    DISLOCATION    OF    THE    FEMUR    WITU 
FRACTURE    OF   THE    ISCHIUM. 

A —  C — ,  age  42,  a  labourer  was  admitted 
April  22nd,  for  treatment  of  injuries  received 
by  the  falling  in  of  a  drain.  The  peculiarities 
of  the  case  were  as  follows : — In  the  recumbent 
position  the  signs  were  evidently  those  of  a 
sciatic  dislocation  of  the  head  of  the  femur  j  in 
the  erect  position  an  intracapsular  fracture  of 
the  neck  would  seem  to  be  indicated  ;  and,  to 
complicate  matters,  on  rotating  the  limb 
some  crepitus  was  apparent,  seemingly  of  a 
cartilaginous  character,  and  proceeding  from 
within  the  capsule.  The  case  was  diagnosed  as 
one  of  sciatic  dislocation  and  manipulation 
was  resorted  to,  but  without  effect,  other  than 
that  the  patient  while  standing  could  now  place 
his  feet  together  which  he  had  previously  been 
unable  to  do.  A  rectal  examination  was  then 
made  which  revealed  at  once  the  cause  of  the 
crepitus  and  of  the  failure  to  reduce,  viz.,  an 
ischiatic  fracture,  extending  from  the  anterior 
margin  of  the  great  sacro-sciatic  notch  forwards 
towards  the  acetabulum,  the  direction  of  the 
plane  of  the  fracture  being  apparently  down- 
wards and  outwards,  the  sharp  edge  of  the 
lower  margin  of  the  fracture  being  easily  de- 
tectable projecting  in  the  opposite  direction. 
Further  attempts  at  reduction  were  now,  of 
course,  out  of  the  question.  Forty-eight  days 
after  the  accident,  the  fracture  having  a}> 
parently  united,  another  effort  was  made  to 
effect  reduction,  but  without  success,  the  bone 
returning  readily  to  its  place,  but  refusing  to 
stay  in  position.  Dr.  Fenwick,  the  distin- 
guished surgeon  of  Montreal,  who  was  present, 
al"K)  kindly  attempted  the  reduction  with  like 


result.  A  t  a  subsequent  consultation  it  was 
decided  to  leave  matters  as  they  were  and  the 
patient  was  discharged  on  the  sixtieth  day  after 
the  accident,  able  to  bear  some  weight  upon  the 
limb,  and  to  go  about  with  crutches. 

FURNEAUX  Jordan's  sponge  dressing. 

This  mode  of  dressing  surgical  wounds  was 
adopted  with  most  gratifying  results  in  the  case 
of  a  female  patient,  aged  52,  after  removal  of 
the  right  breast  for  scirrhus.  The  lips  of  the 
wound  were  maintained  in  apposition  by  means 
of  sutures  and  strips  of  plaster.  The  whole 
surface  adjacent  to  the  incision  was  thoroughly 
washed  with  dilute  carbolic  acid  (1  in  40),  and 
well  disinfected  sponges,  steeped  in  a  1  in  20 
solution  and  wrung  out  as  nearly  as  possible  to 
dryness  were  placed  over  the  line  of  incision 
and  kept  in  position  by  means  of  plaster  strips. 
Free  drainage  was  obtained  by  means  of  a  tube, 
and  the  whole  was  covered  with  an  ordinary 
roller  bandage  confining  the  arm.  Every  couple 
of  hours  the  coverings  were  saturated  with  a 
carbolic  acid  solution  and  the  dressings  were 
renewed  daily,  for  the  first  few  weeks,  subse- 
quently every  other  day.  Under  this  treat- 
ment, the  wound,  which  was  a  very  extensive 
one — the  operation  having  involved  the  re- 
moval of  all  the  axillary  glands  that  could  be 
found,  about  twelve  in  number — healed  rapidly, 
union  taking  place  by  primary  adhesion  along 
its  whole  length,  with  the  exception  of  the  site 
of  insertion  of  the  drainage  tube,  and  of  a  small 
surface  the  size  of  a  ten  cent  piece  where  some 
deep  suppuration  had  occurred.  The  amount 
of  pus  found  on  removing  the  dressings  was 
unusually  small,  at  no  time  exceeding  a  tea- 
spoonful.  The  advantages  of  this  method  are 
various ;  the  sponges  afford  an  equable,  elastic 
pressure,  and  while  almost  perfect  asepticism  is 
secured  the  comfort  experienced  by  the  patient 
is  very  great.  This  patient  suffered  no  pain 
from  first  to  last.  At  the  second  dressing  one 
large  sponge  covering  the  whole  breast  region 
was  substituted  for  the  two  or  three  smaller 
ones.  Mr.  Sampson  Gamgee's  "  Trinity  of 
Healing  Graces," — Rest,  Position,  and  Pres- 
sure were  hereby  well  secured  ;  and  although 
the  dressings  were  not  dry,  they  might  just  as 
well  have  been  infrequent. 


OF  MEDICAL  SCIENCE. 


297 


ROTHELN  OR  GERMAN  MEASLES. 

BY  R.  A.  ALEXANDER,  M.D.,    GRIMSBY,  ONT. 

B&id  before  Ontario  Medical  Association,  June,  1882. 

In    February,    1881,    W F ,    aged 

about  35,  after  feeling  slightly  indisposed  for 
a  day  or  two,  became  covered  with  an  eruption 
somewhat  resembling  measles,  but  without  the 
peculiar  odour  of  that  disease.  He  remembered 
having  had  measles  some  years  before.  Con- 
junctivae intensely  congested  ;  throat  red  and 
sore,  but  no.t  swollen  ;  temperature  101°  ;  did 
not  feel  sick ;  would  not  remain  in  the  house  ; 
went  about  his  work  the  next  day  with  the 
rash  fully  out ;  had  no  complications  nor 
sequelae. 

This  was  the  first  case  of  an  epidemic  of 
Rotheln  or  German  measles,  which  prevailed 
in  this  section  during  the  following  spring  and 
summer.  On  the  15th  of  the  same  month  I 
vaccinated  a  boy  aged  three  years  with  non- 
humanized  vaccine  virus  from  an  ivory  point. 
On  the  24th,  at  the  height  of  the  vaccinia,  he 
had  a  convulsion  and  the  same  day  his  face  and 
body  became  quickly  and  thickly  covered  with 
an  elevated  eruption  somewhat  like  measles. 
The  eruption  consisted  of  elevated  spot^  or 
patches,  some  round,  some  irregularly  shaped, 
of  a  bright]  red  colour.  The  colour,  however, 
varies  a  great  deal  in  difierent  patients.  The 
day  after  the  convulsion  he  was  able  to  be  up 
and  about  the  house,  and  apparently  did  not 
feel  very  sick.  The  disappearance  of  the  rash 
was  very  gradual  and  it  could  be  seen  at  the  end 
of  two  weeks,  whenever  he  became  overheated 
from  any  cause.  There  was  violent  inflammation 
of  an  erysipelatous  character  in  the  vaccinated 
arm,  with  intense  induration  around  the 
pustules,  in  fact  almost  gangrene. 

After  these  two  cases  the  disease  spread 
rapidly  through  the  village,  and  we  were  not 
free  from  it  until  the  ensuing  autumn.  This 
epidemic  was  marked  by  symptoms  common  to 
both  measles  and  scarlet  fever.  The  premoni- 
tory fever  was  short  and  seldom  as  high  as 
102"  Fah.,  and  was  relieved  by  the  coming  out 
of  the  eruption. 

Neither  measles  nor  scarlet  fever  was  preva- 
lent at  the  time. 

Many  of  the  children  whom  I  attended  dur- 


ing this  eruptive  fever  I  had  previously  attended 
for  measles  and  since  for  scarlet  fever. 

My  reason  for  drawing  attention  to  this 
epidemic  is  the  fact,  that  in  several  instances 
facial  erysipelas  occurred  as  a  sequel  within  a 
week  after  the  disappearance  of  the  rash.  In 
five  cases  of  young  ladies  between  the  ages  of 
fourteen  and  thirty  years,  who,  after  the  dis- 
appearance of  the  eruption  and  feeling  very 
well  and  the  weather  being  unusually  fine,  had 
gone  out  walking  or  driving,  erysipelas  of  the 
face  appeared  immediately  and  was  of  a  severe 
type.  One  young  lady  died  suddenly  on  the 
eighth  day. 

In  every  case  the  sequel  occurred  at  the  be- 
ginning of  a  menstrual  period. 

Tinctura  ferri  mur.  was  badly  tolerated  in 
the  erysipelas.     Quinine  acted  well. 


SEPARATION  OF  THE  OLECRANON 
EPIPHYSIS. 

BY  H.  T.  MACHELL,  M.B.,  L.R.C.8.E. 

Surgeon  to  the  Toronto  Dispensary,  and   to  the  Hospital  for 
Sick  Children. 

On  5  th  August  last,  I  was  called  to  see  Dolly 
E.,  aet.  3^  years,  who  hnd  received  an  injury 
in  the  neighbourhood  of  the  elbow-joint.  About 
half-an-hour  previously  she  had  fallen  off"  a  low 
chair,  very  little  more  than  a  foot  high,  her 
arm  coming  under  her.  When  seen,  she  was 
lying  on  a  lounge  with  the  arm  extended  by 
her  side.  There  was  little  or  no  swelling,  but 
it  was  so  tender,  that  the  slighest  touch  caused 
her  to  scream  out  and  struggle  to  get  away. 
However,  by  simply  running  the  finger  along 
the  posterior  border  of  the  ulna,  a  transverse 
groove  at  the  junction  of  the  olecranon  with  the 
ulna  was  readily  detected.  The  pain  and  ten- 
derness on  the  least  motion  were  so  great,  that 
I  asked  for  professional  assistance,  and  Dr. 
Cameron  saw  the  case  with  me.  .  Under  chloro- 
form the  groove  could  be  easily  made  out,  and 
the  upper  fragment  pushed  down  so  far  as  to 
almost  obliterate  it.  No  distinct  crepitus  was 
observed,  though  once  it  was  thought  to  be 
felt. 

No  other  injury  having  been  made  out, 
a  sole-leather  splint  extending  from  the 
axilla  to  the  hand,  covering  the  anterior  and 


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lateral  surfaces  of  the  arm  was  applied.  A 
good-sized  pad  of  cotton-batting  was  placed 
above  the  olecranon,  and,  at  that  point  ban- 
daged something  after  the  fignre-of-8  style,  with 
a  view  of  dragging  down   the  small  fragment. 

During  the  application  of  the  bandage  the 
forearm  was  rather  forcibly  extended.  The 
child  afterwards  went  about  with  the  arm 
hanging  by  the  side. 

August  15th. — Splint  taken  off.  No  sulcus  ; 
on  the  contrary,  considerable  thickening  could 
be  felt  at  the  point  of  separation.  The  exquisite 
tenderness  of  ten  days  ago  had  disappeared. 
The  splint  was  reapplied  in  the  same  manner 
as  before. 

The  case  is,  I  think,  of  sufficient  interest  and 
rarity  to  be  reported,  as  Hamilton  mentions  only 
one  case,  produced  by  himself  in  reducing  a  dislo- 
cation of  the  forearm  backwards  in  a  child  seven 
years  old.  The  case  above  narrated  is  donbly 
interesting  to  Dr.  Cameron  and  myself,  and, 
perhaps,  also  generally,  on  account  of  the  fact, 
that,  5  weeks  previously  we  had  to  reduce  under 
chloioform  the  same  forearm  dislocated  (par- 
tially) inwards.  The  limb  had  been  subsequently 
confined  for  some  time  in  the  flexed  position, 
and  passive  motions  were  being  regularly  prac- 
tised at  the  time  of  this  second  accident.  Per- 
haps the  partial  rigidity  of  !he  joint  was  one 
factor  in  the  determination  of  the  separation  of 
the  epiphysis. 


HERNIA  OF  THE  OVARY. 

BY    R.  BARRINGTON  NEVITT,  B.A.,  M.D  , 

Surgeon  to  the  House  of  Providence,  Hospital  for  Sick 
Children,  and  Toronto  Dispensary. 

C.  J ,  set    25,  was    confined  of  a    male 

child,  still-born,  August,  1879.  She  suffered 
from  general  weakness  and  there  was  manifestly 
some  subinvolution  of  the  uterus.  The  menses 
did  not  recur  until  December  or  January, 
and  were  accompanied  by  a  great  deal  of 
pain.  At  this  time  the  right  ovary  could 
bte  felt  plainly  enlarged  in  the- right  iliac  fossa. 
In  February,  while  carrying  a  pail  of  water, 
she  slipped,  but  by  a  great  effort  prevented 
herself  from  falling.  She  felt  something  give 
way  in  the  right  groin,  and  was  much  over- 
come by  a  feeling  of  nausea  and  weakness.  She 
recovered   from  this,  and,  in  a  few  days,  when 


her  courses  came  on,  noticrd  a  lump  on  the 
anterior  and  internal  face  of  the  thigh,  about 
tour  fingers'  breadth  below  Poupart's  ligament. 
It  was  as  large  as  a  hen's  egg,  tense  and  tender, 
with  pain  radiating  down  the  thigh  and  across 
the  abdomen  and  towards  the  sacrum.  Pressure 
aggravated  the  pain,  and  squeezing  prodiiced  a 
sickening  sensation  with  severe  pain.  After 
the  flow  ceased,  the  pain  and  swelling  subsided. 
The  lump  was  more  or  less  ovoid  in  shape, 
and  flattened,  and  had  a  prolongation  towards 
the  inguinal  canal.  There  was  no  resonance,  but 
an  impulse  on  coughing.  It  had  a  firm  glandular 
feel,  and  on  pinching  gave  rise  to  the  peculiar 
pain  spoken  of  above.  All  attempts  at  reduc- 
tion were  fruitless.  At  each  month  the 
tumour  enlarged  and  became  exquisitely  tender, 
and  there  wga  great  dysmenorrhcea,  the  menses 
recurring  more  frequently  than  natural. 
A  last  attempt  at  reduction  after  raising  the 
hips,  lowering  the  shoulders,  and  flexing  the 
thighs  upon  the  abdomen,  by  the  use  of 
continued  rather  forcible  pressure  in  the  direc- 
tion of  the  inguinal  canal,  caused  the  tumour 
to  disappear  with  a  sudden  slip,  but  no  gurgle 
accompanied  the  return.  There  was  a  quick 
subsidence  of  the  sharp  lancinating  pains,  and 
she  was  able  to  walk  without  the  agony  she 
had  experienced  previously.  After  walking  a 
short  distance  the  hernia  recurred  and  was 
easily  replaced.  The  failure  of  my  first  attempt 
at  the  taxis  may  have  been  due  to  the  fact  that 
I  mistook  the  tumour  for  an  epiplocele  through 
the  femoral  canal,  and  the  force  applied  was  mis- 
directed. Afterwards,  when  I  discovered  the 
cordlike  prolongation  toward  the  inguinal  canal, 
the  attempt  was  successful.  The  tumour  was 
at  all  times  movable. 


A  CA.SE  OF  RAILWAY  INJURY  WITH 
LOSS  OF  BRAIN  SUBSTANCE. 

BY  A.  m'pHEDBAN,  M.B. 

Surgeon  to  Toronto  Dispensary. 

The  following  case  is  sufficiently  interesting 

to  be  placed  on  record  : — W ,  a  girl  aged  9, 

was  struck  by  a  train  as  it  was  entering  Oshawa 
station,  June  17th,  1876.  Through  the  kind- 
ness of  Dr.  Rae,  to  whom  I  am  indebted  for 
these  notes,  I  saw  the    child  with  him  shortly 


OF  MEDICAL  SCIENCE. 


299 


afterwards.  She  was  comatose.  The  scalp 
was  cut  in  several  place?.  Blood  flowed  freely 
from  the  mouth,  nose,  and  ears;  and  there  was 
subconjunctival  extravasation.  Two  pieces  of 
brain  substance,  each  as  large  as  a  bean,  escaped 
from  the  left  ear  with  the  blood.  The  left 
humerus  and  clavicle  were  broken,  and  the 
arms  and  legs  much  cut  and  bruised.  Coma 
continued  for  several  days.  The  bleeding  from 
the  ears,  which  persisted  for  some  time,  was 
followed  by  a  serous  flow.  Consciousness 
gradually  returned,  and  she  slowly  improved 
till  complete  recovery  took  place.  Her  hearing 
was  deficient  before  the  accident,  caused  by  an 
attack  of  scarlet  fever  ;  the  deafness  is  consid- 
erably more  mai'ked  now,  though  not  complete. 


PROGNOSTIC  SIGNIFICANCE  OF  THE 
TEMPERATURE  IN  VARIOUS  AF- 
FECTIONS OF  THE  CENTRAL  NER- 
VOUS SYSTEM. 

BY    OBERSTEINER. 

In  apoplexy  the  temperature  is  first  lowered 
and  for  some  hours,  then  for  many  is  main- 
tained between  37°.5  and  38°.5  (C).  99°.5  and 
10°i.3  F. 

The  fall  is  considerable  in  cases  rapidly  mor- 
tal (as  far  as  35°).  (95°  F.)  It  persists  or  is  fol- 
lowed by  a  quick  and  considerable  ascent. 

In  embolism  the  initial  fall  is  wanting  or 
insignificant  generally  there  is  a  rapid  ascen- 
sion, then  return  to  the  normal  and  notable 
oscillations.  When  the  issue  is  going  to  be  fatal 
we  observe  a  slow  ascension  which,  however, 
does  not  attain  the  high  degrees  of  fatal 
apoplexy. 

In  epileptic  attacks,  the  temperature  rises  to 
38°.5  (C).    101°.3  F. 

A  quarter  of  an  hour  to  a  half  hour  after 
the  end  of  the  attack  defervescence  begins, 
which  is  completed  only  at  the  end  of  ten 
hours.  Subintrant  attacks  cause  the  tempera- 
ture to  rise  to  40°  and  41°.  (C).  104°  and  105° 
.8F. 

In  uraemic  attacks  the  schema  is  very 
nearly  that  of  apoplexy  :  fall  at  the  beginning 


then  hyperthermy   and  oscillations  above  37° 
(C).     (F°98°.6) :  Return  to  the  normal. 

The  attacks  of  divers  nature  (epileptic,  cata- 
leptic, apoplectic,  &c.,  that  are  met  with  in  the 
course  of  general  paralysis,  would  be  annnouced 
two  or  three  days  in  advance  by  a  lowering  of 
the  temperature,  one  might  then  administer  in 
time  chloral,  which,  according  to  Konig,  is 
capable  of  calming  the  convulsive  crisis. 
During  the  attacks  the  progressive  fall  of  the 
high  temperature  of  the  beginning  is  a  good 
prognostic.  A  persistant  exacerbation  should 
make  us  suspect  a  fatal  issue. — L' Union 
Medical. 


Heitler  on  Acute  Dilatation  of  the 
Heart. — After  noticing  the  cardiac  dilatation 
which  gradually  occurs  when  the  compensation 
by  hypertrophy  for  valvular  disease  ceases  to  be 
sufiicient.  Dr.  Heitler  says,  that  he  has  also, 
in  many  cases  been  able  to  diagnose  an  acute 
dilatation  of  the  heart  occurring  siiddenly  and 
disappearing  as  suddenly.  (Wien.  Med.  Woch., 
1882,  No.  22.)  This  acute  dilatation  he  s^iys  can 
be  diagnosed  only  by  prolonged  and  careful 
examination.  It  may  aflfect  all  the  cavities  or 
only  one,  the  left  ventricle,  or  the  left  auricle 
alone,  or  only  the  right  side  of  the  heart.  He 
records  a  case  in  which,  fiom  the  physical 
signs,  there  was  evidently  dilatation  of  the 
right  side  of  the  heart,  with  great  palpitation, 
anxiety,  and  cyanosis ;  the  heart  beating 
^^olently  200  times  per  minute,  but  giving  a 
very  weak  pulse.  Within  five  minutes,  when 
he  wished  to  demonstrate  this  condition  it  had 
disappeared  along  with  the  symptoms.  The 
patient  had  mitral  insufficiency  with  stenosis, 
and  suffered  frequently  from  such  attacks.  Dr. 
Heitler  believes,  that  acute  dilatation  frequently 
occurs  in  the  early  stages  of  fevers,  in  endocar- 
ditis, anaemia,  and  Bright's  disease. — London 
Med.  Record. 

Dr.  Lambert  Ott  in  the  Philctdelphia  Medical 
Times,  tabulates  as  a  sign  of  tubercular  menin- 
gitis extreme  tenderness  elicited  on  pressing 
the  femur.  He  discovered  this  incidentally  in 
one  case  and  confirmed  it  in  a  s*  cond  case, 
pressure  upon  other  portions  of  the  extremities 
causing  no  distress  whatever. 


300 


CANADIAN  JOURNAL 


BiZZOZERO  ON  THE  DIAGNOSTIC  SIGNIFICATION 

OF  THK  Alveolar  Epitiiklium  of  tue  Lwng 
IN  Sputum. — The  large  granular  epithelium 
that  appears  in  sputum,  the  writer  considers 
undoubtedly  jn-oceeds  from  the  alveoli.  He 
recalls  the  fact,  that,  in  the  alveoli  there  are 
two  distinct  kinds  of  epithelium,  viz.  :  broad, 
squamal,  and  smaller,  but  thicker,  and  more 
granular  cells.  It  is  the  latter  class  which 
undergoes  rapid  proliferation  in  inflammation, 
the  other  reiuaining  unaltered.  And  it  is  th« 
latter  class  that  appears  in  the  sputum.  When 
present  in  large  quantity,  in  abundant  sputum 
they  form  a  bad  symptom,  as  indicating  a 
general  catarrh  of  the  alveoli ;  but  if  in  small 
quantity,  they  have  no  significance. — Lond. 
Med.  Record. 

Lead  Colic. — M.  Bernutz  has  been  experi- 
menting at  La  Charity  with  Malherbe's  method 
of  treatnglead  colic,  a  mode  of  treatment  resus- 
citated by  Picot,  of  Bordeaux. 

Thirty  years  ago  Malherbe  basing  his  opinion 
upon  a  long  series  of  cases,  advocated  the  use  of 
belladonna  in  massive  doses  in  the  treatnient 
of  lead  colic.  He  found  that  the  tolerance  for 
this  drug  was  in  direct  proportion  to  the 
intensity  of  the  lead  poisoning.  Malherbe's 
plan  was  to  give  five  centigrammes  of  extract, 
belladonnse  every  half  hour  until  20  or  25 
centigrammes  had  been  given.  Concurrently  he 
gave  a  purgative,  as  two  drops  of  croton  oil. 

In  M.  Picot's  observations  the  cure  has  been 
prompt,  the  constipation  being  overcome  after 
the  first  day  and  the  colic  immediately  calmed. 

M.  Bernutz  has  had  to  wait  longer  and  in 
some  cases  was  obliged  the  next  day  to  re- 
commence the  treatment  and  in  some  cases  with 
slight  signs  of  atropinism — Gaz.  des  H6p. 


Progressive  Pernicious  Anemia. — Heitler, 
in  Wien.  Med.  Woch.,  gives  two  exam- 
ples of  progressive  pernicious  &vsemi&,  in 
men  respectively  of  43  and  51  years.  The 
only  lesion  found  on  careful  j?ost-Tnortem  exam- 
ination was  an  atrophied  condition  of  the 
btomach  walls,  with  hard  contracted  b  mds 
passing  in  various  directions,  and  bounding  the 
degenerated-  portions.  This  makes  it  an 
atrophic  dyspepsia. 


Deuker's  Treatment  of  Diphtheria. — In 
24  years'  experience  in  the  Children's  Hospital 
in  St.  Petersburg,  Dr.  Deuker  has  treated, 
says  the  Medical  Press,  upward  of  2,000  cases  of 
diphtheria,  and  having  tried  all  remedies, 
internal  and  external,  has  preferred  the  follow- 
ing for  the  last  ten  years ; — As  soon  as  the 
white  spots  appear  he  gives  a  laxative  mainly 
composed  of  senna  which  produces  an  abundant 
evacuation.  After  its  effect  has  ceased,  he 
gives  cold  drinks  acidulated  with  hydrochloric 
acid,  and  every  two  hours  a  gargle  composed  of 
lime-water  and  hot  milk  in  equal  parts.  When 
commenced  early  it  is  generally  and  rapidly 
successful. 

The  Chlorate  and  the  Chloride  of 
Potassium.— The  editor  of  the  Phila.  Med. 
and  Surg.  Reporter  suggests  that  the  discrep- 
ancy in  the  results  of  the  use  of  this  potash  salt, 
here  and  on  the  Continent  of  Europe,  as  a 
gargle  and  mouth  wash,  especially  in  mercurial 
stomatitis,  is  due  to  the  fact  that  we  use  the 
chlorate  (K  CI.  OgS)  while  there  the  chloride 
(K  CI.)  is  employed.  Prof.  Wertheim  says  the 
former  in  concentrated  solution  is  poisonous, 
while  the  latter  is  innocuous,  an  analogue  of  com- 
mon salt,  a  specific  in  sore  throat,  and  es])ecially 
in  mercurial  sore  mouth. 


ingworm  of  the  Scalp. — Dr.  John  Cavafy 
in  British  Medical  Journal,  recommends  the 
employment  of  a  solution  of  boracic  acid,  20 
grains  in  an  ounce  of  spirit,  to  which  a  drachm 
of  ether  has  been  added.  This  lotion  is  to  be 
forcibly  rubbed  into  affected  parts  of  scalp, 
with  a  rag,  or  moderately  stiff  brush,  three 
times  daily  ;  the  whole  head  being  ordered  to 
be  washed  every  morning  with  plenty  of  hot- 
water  and  soap.  Like  all  other  parasiticide 
applications,  this  must  be  continued  long  after 
all  signs  of  the  disease  have  disappeared. 


M.  Baibier  finds  powdered-roasted  coffee  an 
excellent  deodorizer  and  disinfectant.  The 
coffee  is  simply  scattered  over  and  about  the 
place  or  thing  requiring  disinfection.  He  has 
used  it  in  autopsies  and  on  bodies  a  stinking 
mass  of  putrefaction,  also  as  a  dressing  to  foul 
virulent  ulcers. — France  Med. 


OF  MEDICAL  SCIENCE. 


301 


^UVQtV\$. 


Complete  Lateral  Dislocation  of  the 
Elbow-joint. — Dr.  Oscar  Leedun  records  in 
Phila.  Med.  and  Surg.  Reporter,  an  unique 
case  of  complete  outward  dislocation  of  both 
bones  of  the  forearm  produced  by  a  fall  from 
a  cart  in  which  the  left  arm  was  caught  in  the 
wheel.  The  olecranon  was  twisted  ai-ound 
nearly  in  front  of  the  joint,  passing  completely 
over  the  external  condyle,  while  the  head  of 
the  radius  was  dislocated  forward  and  inward. 
Reduction  was  successfully  accomplished  ;  some 
stiffness  of  the  joint  remaining. 


In  the  Medical  New§  for  19ih  August,  Dr. 
Jt)hh  A.  Sieber,  of  Ferdinand,  Ind.,  records  a 
case  of  complete  outward  dislocation  of  the 
radius  and  ulna.  He  says  that  French  authors 
record  eleven  such  cases.  The  patient  in  this 
case  was  a  little  girl,  nine  years  old,  who  had 
fallen  about  two  feet  from  a  log  crossing  a 
brook. 


To  determine  during  an  operation  the  direc- 
tion of  an  exposed  loop  of  bowel,  it  suffices  to 
apply  to  the  serous  surface  for  a  couple  of 
moments  a  soda  salt  ;  according  to  Nothnagel, 
a  contraction  will  be  produced  which  will 
invariably  extend  in  a  direction  upwards, 
towards  the  pylorus.  The  contact  of  a  potash 
salt  will  likewise  determine  a  contraction  of  the 
muscular  coat,  but  it  is  less  marked,  is  localized, 
and  does  not  extend  in  either  direction. 


GoNORRHffiA. — Dr.  D.  W.  C.  Wade,  in  the 
Transactions  of  the  Michigan  State  Medical 
Society,  recommends  :  Take  iodoform,  pulver- 
ised, two  drachms  ;  subnitrate  of  bismuth,  two 
drachms  ;  chloral  hydrate,  fifteen  grains ;  mor- 
phine, five  grains ;  oil  of  rose  geranium, 
twenty  drops ;  cacao  butter,  one  ounce.  Mix, 
and  make  twenty-four  suppositories  ^  of  an 
inch  in  diameter.  Write  :  One  suppository  to 
be  pushed  into  the  urethra  three  times  daily. 


New  Method  of  Treating  Salivary  Fis- 
tula.— At  the  meeting  of  the  Society  de 
Chirurgie,  held  July  5th,  M.  Delens  read  a 
report  on  a  work  of  M.  Richelot  on  this  subject. 


His  method  consists  in  forming  an  internal 
orifice  to  the  fistula  by  tying  the  thickness  of 
the  cheek  in  the  grasp  of  an  elastic  ligature  ; 
after  the  ligature  has  cut  through,  the  external 
orifice  closes  of  itself  while  the  other  remains 
open. — Le  Fr ogres  MMical,  Medical  News. 


Nerve  Stretching  in  Sciatica. — In  the 
Northwestern  Lancet,  for  Ist  August,  Dr.  Albert 
E.  Senkler,  of  St.  Paul,  Minn.,  (formerly  of 
Toronto)  reports  a  case  of  inveterate  and 
disabling  sciatica  in  which  all  remedies,  in- 
cluding the  galvanic  current,  had  failed  to 
afford  relief,  and  in  which  immediate  improve- 
ment followed  stretching  of  the  nerve  after 
exposure  by  dissection,  succeeded  after  th© 
lapse  of  a  week  by  forced  flexion  of  the  thigh 
on  the  trunk,  the  leg  being  extended. 


Optic  Nerve  Stretching.— Dt.s.  Wecker 
and  Kummel  have  both  had  cases  of  stretching 
the  opticnerve.  The  patientis  deeplynarcotized, 
and  a  cut  made  in  the  conjunctiva  from  the  in- 
sertion of  the  ext.  rect.  to  the  inferior  rect,  a 
short  distance  from  the  cornea.  The  conjunc- 
tiva is  then  separated  from  the  eye  and  a  strab- 
ismus hook  passed  round  the  nerve,  which  is 
powerfully  stretched.  These  operations  were 
j)erformed  for  amaurotic  states  of  the  eye. 
Before  the  operations,  the  hand  could  be  dimly 
seen  at  1 1^  feet.  Two  months  after,  the  fingera 
at  7  feet,— TTien.  Med.  Woch. 


Ligature  of  the  Innominate. — The  case 
on  which  Mr.  Wm.  Thomson,  of  Dublin,  per- 
formed this  operation  in  June  last  succumbed 
on  the  forty-second  day  thereafter.  There  had 
been  secondary  haemorrhage,  but  none  after  the 
thirty-ninth  day.  The  external  wound  had 
healed,  all  but  a  very  small  sinus,  which  was 
found  to  terminate  in  an  ulcer  involving  the 
anterior  wall  of  the  junction  of  subclavian, 
carotid  and  innominate  arteries.  The  two  last 
named  vessels  were  filled  with  clot,  and 
the  subclavian  was  occluded  to  the  extent  of 
^  an  inch.  The  ulcer  was  on  the  distal  side 
of  the  ligature  ;  and  the  haemorrhage  had  ap- 
parently come  from  the  innominate,  there  being 
a  recent  blood  stain  on  the  cardiac  side  of  the 
clot.      None   of   the    vessels  was   pervious  to 


302 


CANADIAN  JOURNAL 


water  forcibly  injected.  Aorta  atlieromatouH. 
Tumour  undergoing  satiafactory  consolidation. 
Out  of  sixteen  cases  now  recorded  but  one 
(Smith's,  of  New  Orleans)  has  survived  the 
o|)eration.  Graefe's  case  lived  sixty-seven 
days ;  Thomson's,  forty-two  days ;  Cooper's, 
thirty-four  days. 


Sub-Periosteal  Amputations. — M.  Henriet 
has  recently  devoted  some  attention  to  this  old 
subject.  The  operation  consists  in  dividing  the 
periosteum  at  a  lower  point  than  that  at  which 
the  bone  is  to  be  sawn,  and  then  stripping  it 
up  to  this  point,  so  that  after  section  of  the 
bone,  a  cufl'  of  periosteum  projects  beyond  it. 
In  a  patient  of  M.  Meaise,  autopsy  showed  the 
periosteum  completely  covering  in  the  cut  sur- 
face of  the  bone,  and  finally  adherent  to  it, 
thus  closing  the  medullary  cavity,  and  probably 
preventing  the  usual  haemorrhage  therefrom. 
"The  periosteum  of  the  adult  (N,  Y.  Med. 
Record),  which  has  completed  its  task  of  bone 
formation,  lacks  the  qualities  suited  for  the 
purpose,  and  is  thin  as  compared  with  the  same 
membrane  in  its  active  period  of  development 
or  about  an  inflamed  joint.  M.  Oilier,  how- 
ever, believes,  that  it  is  an  operation  admitting 
of  generalization,  the  dangers  being  on  the  side 
of  excessive  bone  tormation.  Thus,  in  young 
children  he  has  foxmd  the  periosteum  produce 
osteophytes  to  the  damage  of  the  stump."  M. 
Henriet  also  cautions  us  that  we  do  not  need  too 
much  ;  and  says,  that  absolute  integi-ity  of  tiie 
periosteal  flap  is  not  indispensable,  and  perhaps 
not  even  desirable. — Lond.  Med.  Record. 


Sciatica — In  a  clinical  lecture  on  Sciatica, 
Mr.  Jonathan  Hutchinson  {^Medical  Times  and 
Gazette)  says,  "  In  nineteen  ca.ses  out  of  twenty 
in  which  the  diagnosis  of  sciatica  is  suggested, 
there  is  no  affection  of  the  sciatic  nerve  what- 
ever. They  are  simply  cases  of  arthritic  dis- 
ease of  the  hip  in  one  or  other  of  its  various 
forms, — acute  gout,  chronic  gout,  rheumatic 
gout,  subacute  rheumatism,  or  chronic  senile 
rheumatism.  Both  by  the  public  and  the 
profession  these  cases  are  constantly  called 
*  sciatica.'  Our  workhouse  infirmaries  are  full 
of  chronic  cases  under  that  name,  and  I  speak 
advisedly  when  I  say  I  feel  sure  that  they  are 


almost  all  examples  of  morbua  coxae  senilis. 
Of  the  cases  of  '  Sciatica '  which  are  not  hip 
joint  rheumatism,  son^e  are  probably  aff"ection8 
of  the  fascia  or  periosteum  near  to  the  hip ;  a 
minority  are  possibly  affections  of  the  sciatic 
nerve  itself.  In  these  latter  it  is  the  sheath 
of  the  nerve  which  becomes  painful.  The 
pain  may  be  darting,  or  may  radiate,  but  it 
does  not  pass  down  the  nerve  tubules  or  in 
any  way  make  the  patient  conscious  of  their 
course.  The  diagnosis  of  true  sciatica  is  to  be 
based  upon  the  discovery  of  tenderness 
restricted  to  the  trunk  of  the  nerve,  and  in- 
volving a  considerable  part  of  its  course.  Ex- 
amples of  this  are  decidedly  rare,  and  their 
recognition  without  risk  of  error  is  a  matter  of 
great  difiiculfcy. — Philadelphia  Medical  Times. 


PitUriffrij. 


In  the  Obstetrical  Society  of  Edinburgh,  a 
case  of  pregnancy  at  49  (a  primipara),  one  of  a 
"  maiden"  at  50,  and  a  third  at  62  were  reported. 


Vaginitis. — R.  Acid,  tannic "jxss; 

Amyli 3  iv-/,  iij  ; 

Ung.  petrol ei....   5  iv-7;  iij. 
M.     Sig.     Use  from  one  to  two  drachms  on 
absorbent    cotton   as   a   tampon. — Med.   Surg. 
Reporter. 


Sore  Nipples. — Cold  applications — tannin 
and  glycerine,  slight  touching  with  nitrate  of 
silver  or  Peruvian  bark  4,  to  8  of  almond  oil, 
6  of  mucilage  of  gum  Arabic,  and  35  of  rose- 
water,  applied  every  hour,  will  heal  sore 
nipples  in  a  few  days. — Rudolf  Tauzsfcy, 
Medical  Neios. 


Accidental  Removal  of  Uterus  ;  recovery. 
— Mr.  Hopkins  Walter  (Reading)  exhibited  a 
uterus  with  one  ovary  and  Fallopian  tube, 
and  a  piece  of  omentum,  that  had  been  torn 
away  by  a  midwife  in  the  attempt  to  remove 
an  adherent  placenta.  The  patient  made  an  ex- 
cellent recovery.  He  hoped  at  a  future  meet- 
ing to  communicate  a  full  account  of  the  case. 


OF  MEDICAL  SCIENCE. 


303 


Opthalmia  Neonatorum. — Dr.  Cred^  says 
that  he  has  treated  over  three  hundred  new-born 
children  in  the  following  way  : — Immediately 
after  the  first  washing,  the  eyes  are  dried  with 
a  clean  rag,  and  one  drop  of  a  2  per  cent,  solu- 
tion of  nitrate  of  silver  put  into  each,  with  a 
small  glass  tube.  Not  one  of  these  children  be- 
came affected  with  opthalmia,  notwithstanding 
that  many  were  born  in  unfavourable  condi- 
tions. He  shows  that  nitrate  of  silver  is  the 
best  preventive  remedy,  and  praises  it  warmly. 
—  Wie7i.  Med.  Woch. 


Prof.  Spaeth,  of  Vienna,  performed  Csesarean 
section  and  sewed  up  the  uterine  wound  with 
five  deep  and  four  superficial  catgut  stitches, 
largest  size  of  Lister's  antiseptic  chromic  acid 
ligature.  The  woman  died  forty-eight  hours 
after  of  peritonitis.  The  autopsy  was  suprising 
in  its  revelations.  Every  catgut  suture  in  the 
uterine  tissue  was  found  untied  and  straight- 
ened out  while  the  wound  was  open  and 
gaping,  the  lochial  discharges  having  escaped 
into  the  peritoneal  cavity.  The  original  knots 
in  the  catgut  had  been  tied  with  especial  care 
by  Prof.  Weinlechner. — Philadelphia  Medical 
Times. 


Dr.  T.  Halbertsma,  "On  the  Etiology  of 
Puerperal  Eclampsia,"  in  Wien.  Med.  Woch., 
says  that  all  previous  observations  on  the 
cause  of  eclampsia  are  giving  way,  and  seeks 
for  a  new  clear  foundation.  He  has  now  for 
an  entire  year  declared  that  puerperal 
eclampsia  might  be  caused  by  the  pressure 
which  the  ureters  receive  from  the  side  of  the 
extending  uterus.  This  hypothesis  then  met 
with  contradiction ;  this  could  not  be  the 
exciting  cause,  as  we  do  not  meet  with 
eclampsia  in  ovarian  tumours.  Whereupon  he 
attempts  to  establish  afresh  his  hypothesis. 
L  The  ureters  pass  I'ound  the  uterus  from  above 
and  behind,  to  before  and  below,  and  can 
very  easily  be  compressed.  This  relation  does 
not  exist  in  the  case  of  the  ovaries.  2.  By 
experiment  it  is  clear  that  the  secretion  pressure 
in  the  kidneys  is  always  very  slight,  therefore, 
if  both  ureters  are  compressed,  the  flow  of 
urine  can  easily  be  stopped.  3.  Clinical 
observation  teaches  that  a  small  evacuation  of 
urine  is  one  of  the  strongest  forerunning 
symptoms  of  eclampsia,  and  that  this  retention 
can  almost  invariably  be  traced  to  compression 
of  the  ureters. 


RUSANOVSKY  ON  Le  Bon's  MeTHOD  FOR   THE 

Treatment  of  Still-born  Infants. —  Dr. 
Rusanovsky  (Vratch,  1882,  No.  1)  relates  a 
very  interesting  and  instructive  case  of  as- 
phyxia neonatorum,  in  which,  after  entirely 
unsuccessful  application  of  the  usual  methods 
(including  Schultze's),  he  resolved,  in  extremis, 
to  try  hot-water  treatment,  lately  recommended 
for  Btill-birth  by  Dr.  Le  Bon.  As  there  was 
no  bath  at  hand,  the  author  took  a  common 
iron  pail,  filled  it  with  very  hot  water,  and  at 
once  immersed  the  infant  (who  was  pulseless 
and  cold),  leaving  free  the  head  alone.  One 
minute  afterwards — eighty-seven  minutes  after 
birth — the  first  inspiration  was  made,  and  the 
child's  life  was  saved.  The  author  points  out 
that  Le  Bon's  method  is  exceedingly  simple, 
easy,  conveniently  practicable  under  all  circum- 
stances, and  does  not  fatigue  the  obstetrician. 
As  to  the  rationale  of  the  method,  the  author 
is  of  opinion  that  the  first  inspiratory  move- 
ment results  from  the  powerful  exciting  influ- 
ence produced  by  hot  water  upon  the  peripheral 
nerves  of  the  skin,  and  from  the  subsequent 
reflex  action  of  the  respiratory  centre  in  the 
medulla  oblongata  — London  Med.  Record, 


The  University  of  Virginia. — A  corres- 
pondent of  the  ^ew  Orleans  Medical  and 
Surgical  Journal  writes  as  follows  of  the 
University  of  Virginia  :  "  Had  our  Southern 
neighbours  no  other  boast,  they  might  well  be 
proud  of  that  University.  Let  us  see  what 
percentage  of  each  class  is  graduated  there.  I 
have  accurate  data  for  two  years  only.  In 
1878-79  there  were  53  men  in  the  medical  class  ; 
48  of  these  applied  for  graduation,  and  21 
alone  were  successful.  In  1879-80  there  were 
46  in  the  class;  31  applied  and  10  only 
graduated.  I  had  almost  as  soon  be  one  of 
those  10  as  a  survivor  of  the  600  at  Balaklava. 
Can  we  wonder  at  the  small  classes  there  1 
But  the  men  of  that  faculty  prefer  a  small 
class  to  a  large  one,  where  the  pen  which  titles 
a  fool  tells  a  lie  at  every  stroke." 
►-«♦>-< 

A  hospital  nurse  on  being  asked  which  was 
the  most  dangerous  case  in  the  ward,  jwinted 
to  the  surgeon's  instrument  case. — Mich.  Med. 
New*. 


304 


CANADIAN  JOURNAL 


(ffom$|Jonclrnrf. 


To  the  Editor  of  the  Canadian  Journal  op  Mboical  Scibnci. 

CLINICAL   EXAMINATIONS. 

Sir, — The  importance  of  thoroughly  testing 
the  practical  knowledge  of  candidates  is  now 
universally  recognized,  and  every  year  the 
clinical  part  of  the  final  examination  takes  a 
more  prominent  place.  A  man  may  crain 
enough  to  enable  him  to  pass  a  good  wi-itten 
and  oral  examination,  and  at  the  same  time  be 
utterly  unfit  to  ])ractice  medicine.  Let  me 
give  an  instance.  A  few  years  ago  I  happened 
to  be  present  at  the  oral  examination  of  candi- 
date A,  who  had  already  been  rejected  once. 
The  subject  was  practice  of  medicine,  an  1  he 
made  a  Jirst-class  examination,  so  much  so  that 
another  gentleman  who  was  present  expressed 
no  little  astonishment  at  the  fluency  and  excel- 
lence of  the  answ^ers.  His  written  paper  was 
of  the  same  character.  The  clinical  examination 
showed  that  this  man  was  hopelessly  ignorant 
in  the  practical  application  of  his  knowledge. 
I  was  permitted  afterwards  to  see  the  written 
report  on  a  case  for  which  he  had  an  hour.  It 
was  simply  atrocious,  and  displayed  ignorance 
of  the  first  principles  of  diagnosis.  The  clini- 
cal examination  was  the  cause  of  his  rejection; 
But  what  of  that !  He  did  not  care,  as  he  got  a 
license  to  practise  in  a  short  time  from  a 
Board  without  clinical  examinations. 

No  better  plan  can  be  followed  than  that 
adopted  by  the  London  Board — the  student  is 
sent  to  the  Hospital,  and  has  an  hour  or  an 
hour  and  a-half  with  the  Medical  Examiner, 
and  the  same  time  with  the  Surgical  one.  He 
prepares  a  report  on  a  case ;  sees  one  or  two 
other  patients ;  examines  secretions  chemically 
and  microscopically,  and  has  questions  upon 
them.  To  conduct  such  examinations  properly, 
ample  time  must  be  given,  as  not  more  than 
eight  or  ten  men  could  Vjc  examined  in  a  single 
day. 

I  have  the  honor  to  remain, 
Yours,  «kc., 

Practitioner. 


Bodies  used  for  anatomical  purposes  in  Paris, 
are  henceforth  to  be  cremated. 


THE  CANADIAN 

loiirnai  of  lltlifiii  Iritiirf; 

A  Monthly  Journal  of  Medical  Science,  Criticism, 
and  News. 

To  Correspondents. —  We  shall  be  glad  to  re- 
ceive from  our  friends  everywhere,  current  jnenical 
news  oj  e;eneral  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwardimr  reports  of  the  proceedings  of  their 
Associations. 

TORONTO,  SEPTEMBER,  1882. 

MEETING  OF  THE  CANADA  MEDICAL 
ASSOCIATION. 

This  year's  meeting  of  this  Association  will 
be  opened  on  Wednesday  morning,  September 
6th,  in  the  City  Council  Chamber,  which  is 
situated  south  of  the  St.  Lawrence  market,  Tor- 
onto ;  the  President,  Dr.  Fenwick,  of  Montreal, 
occupying  the  chair.  It  has  been  decided  by 
the  Committee  of  Arrangements  to  have  the 
meeting  last  three  days  instead  of  two,  i.e., 
through  Wednesday,  Thursday,  and  Friday. 

As  we  stated  in  our  last  issue.  Dr.  Daniel 
Clark,  Superintendent  of  the  Toronto  Asylum 
for  Insane,  will  entertain  the  members  at 
luncheon,  probably  on  Thursday.  The  recep- 
tion by  the  profession  of  Toronto  to  those 
coming  from  a  distance  will  be  given  on  Thurs- 
day evening  in  the  Normal  School  buildings, 
and  will  take  the  form  of  a  conversazione. 
The  Chairman  of  the  Committee  of  Arrange- 
ments, Dr.  Canniff",  will  occupy  the  chair  on 
that  occasion,  and  it  is  expected  that  our  dis- 
tinguished veteran.  Dr.  Workman,  will  deliver 
an  address  of  welcome  to  the  outsiders,  to 
which  Dr.  Fenwick  will  probably  respond. 
During  the  rest  of  the  evening  the  guests 
(including  ladies)  will,  it  is  expected,  enjoy 
themselves  by  listening  to  the  music  which 
will  be  provided,  promenading  through  the 
spacious  and  handsome  buildings  in  free  and 
unconventional  conversation,  partaking  of  re- 
freshments to  be  provided  in  the  shape  of  a 
substantial  supper,  <fec. 

The  Directors  of  the  Industrial  Association 
kindly  invited  the  members  to  attend  the 
formal  opening  of  the  Exhibition,  which  is  to 


OF  MEDICAL  SCIENCE. 


305 


take  place  on  Wednesday  afternoon,  but  as 
this  would  interfere  with  one  of  the  most  im- 
portant sessions  of  the  meeting,  the  Committee 
was  unable  to  accept  the  invitation. 

We  learn  from  the  General  Secretary,  Dr. 
Osier,  of  Montreal,  that  several  who  have 
signified  their  intention  to  read  papers  have 
not  yet  officially  notified  him.  Such  parties 
are  requested  to  do  so  at  once.  Arrangements 
have  been  made  with  the  different  Railway  and 
Steamboat  Companies  for  reduced  rates,  and 
the  necessary  certificates  may  be  obtained  from 
the  General  Secretary,  or  any  of  the  local 
Secretaries,  Dr.  A.  H.  Wright,  Toronto ;  Dr. 
Belleau,  Quebec ;  Dr.  Rigby,  Halifax ;  Dr. 
C.  Holden,  St.  John. 

We  hope  members  of  the  Profession  will 
remember  that  the  museum  will  be  one  of  the 
most  important  features  of  this  meeting,  and 
will  endeavour  to  gather  together  a  collection 
of  specimens,  including  those  pathological  and 
physiological,  as  well  as  all  kinds  of  appliances, 
surgical  and  otherwise,  which  will  be  alike 
creditable  and  instructive. 

The  following  papers  are  among  those 
promised  : 

(1)  Dr.  Goodwillie,  New  York,  "  New 
Operation  for  Closure  of  Hare  Lip,  and  the 
Hard  Palate  Immediately  after  Birth  ;  (2)  Dr. 
Walker,  Detroit,  "  Stone  in  the  Bladder  ; "  (3) 
Dr.  A.  A.  Browne,  "  Some  points  in  Forceps 
Application;"  (4)  Dr.  Buller,  "The  Electro- 
Magnet  in  Ophthalmic  Practice ; "  (5)  Dr. 
Sutherland,  "  Exhibition  of  a  Series  of  Speci- 
mens Illustrating  the  Modes  of  Termination  of 
Aneurism ;"  (6)  Dr.  J.  C.  Cameron,  "  Axis 
Traction ;"  (7)  Dr.  F.  J.  Shepherd,  "  On  Cer- 
vical Eibs  ;  "  (8)  Dr.  F.  J.  Shepherd,  "  Note 
on  the  Treatment  of  Mammary  Abscess ;"  (9) 
Dr.  Alloway,  "Exhibition  of  (1)  a  Model  of 
a  Gynaecological  Couch,  (2)  of  a  New  Speculum, 
(3)  of  an  Ether  Inhaler  ;"  (10)  Dr.  Gardner, 
"Rare  Form  of  Uterine  Tumour;"  (11)  Dr. 
Hingston,  "On  Certain  Obstructions  in  the 
Air  Passages;"  (12)  Dr.  Osier,  "On  Echin- 
ococcus.  Disease  in  America  ;"  (13)  Drs.  Osier 
and  Oakley,  "  Demonstration  of  Tubercle 
Bacilli;"  (14)  Dr.  Harrison,  Selkirk,  "A 
Peculiar  Form  of  Fever ;"  (15)  Dr.  Ferguson, 
"Parasitic  Diseases  of  the  -Ear;"  (16)  Dr. 
Ferguson,  "  Report  of  Three  Cases  of  Eczema." 
(17)  Dr.  Fulton,  "Polypoid  Fibroma  of  the 
Bladder." 


PERCENTAGE  ON  PRESCRIPTIONS. 

There  has  been  a  good  deal  of  discussion  in 
the  lay  press  on  the  subject  of  the  receipt  of  a 
percentage  on  prescriptions  by  physicians  from 
druggists.  One  of  the  Toronto  papers 
especially  which  has  generally  been  very  fair 
in  its  reference  to  the  medical  profession  has 
had  a  good  deal  to  say  on  the  subject  on 
various  occasions,  and  has  frequently  made  the 
very  serious  statement  that  such  a  practice  is 
quite  common  among  the  physicians  of  Toronto. 
We  would  like  to  think  that  the  practice  is  not 
common  here,  but  regret  exceedingly  that  we 
are  unable  to  say  that  such  is  the  case.  There 
is  no  doubt  that  a  number  of  physicians  do 
take  the  percentage,  and  in  fact  make  quite  a 
revenue  from  it. 

To  any  fair-minded  man,  be  he  professional 
or  otherwise,  there  can  scarcely  be  two 
opinions  on  the  subject.  The  practice  is  most 
reprehensible  in  every  respect,  and  we  can  only 
wonder  why  it  has  ever  received  any 
countenance.  It  is  neither  dignified  from  a 
professional  point  of  view,  nor  straightforward 
in  a  business  aspect.  It  is  a  mean  petty  way 
for  the  physician  to  make  a  few  cents  extra  on 
a  consultation,  while  at  the  same  time  an 
injustice  is  being  done  to  the  public,  because, 
argue  as  you  will,  the  precentage  comes  out  of 
the  patients'  pockets,  and  that  too  without 
their  knowledge,  if  we  except  the  few  who 
have  become  initiated. 

We  have  no  intention,  however,  of  discussing 
the  matter  in  detail,  but  simply  allude  to  it  at 
the  present  time  with  the  hope  that  members 
of  the  profession,  or  at  least  those  opposed  to 
the  practice,  will  do  all  in  their  power  to 
stamp  out  the  pernicious  custom. 


CLINICAL  EXAMINATIONS. 

We  publish  in  this  issue  a  letter  from 
"  Practitioner,"  to  which  we  direct  the  atten- 
tion of  Dr.  Burns,  and  other  members  of  the 
Medical  Council  who  take  an  especial  interest 
in  the  subject  of  Clincial  Examinations.  As  the 
writer  of  the  letter  is  one  of  the  ablest  Clinical 
teachers  we  have  in  the  country,  his  opinions 
are  well  worth  careful  consideration,  and  we 
cordially  endorse  the  views  he  expresses,  and 
the  plan  he  proposes,  i.  e.,  the  one  adopted  by 
some  of  the  examining  bodies  in  England. 


306 


CANADIAN  JOURNAL 


DOCTORS'  SIGNS. 

We  believe  it  is  frequently  remarked  by 
strangers  visiting  Toronto,  that  the  Doctors' 
signs  in  this  city  are  the  most  extensive  and 
gorgeous  now  known  in  the  world.  It  is  but 
a  few  years  since  the  modest  and  old-fashioned 
door-plate,  with  "  Mr.  Smith,  Surgeon,"  or 
"  Dr.  Jones  "  sufficed.  Suddenly,  however, 
an  enterprising  medico  exhibited  a  fan-liglit, 
adorned  with  his  name,  over  his  door,  much  to 
the  horror  of  the  numerous  conservative  mem- 
bers of  the  profession.  This  was  but  the 
beginning,  and  they  soon  became  generally 
used,  the  patterns  and  embellishments  being 
numerous  and  varied.  At  first  simply  the 
name  a})peared,  and  perhaps  street  number; 
now  we  have  ''  office  hours,"  covering  immense 
spaces,  beautifully  coloured,  in  some  cases ;  in 
othei-8  a  good  portion  of  the  alphabet,  in  capital 
letters,  after  the  name.  Sometimes  tin  plates 
adoiii  various  parts  of  the  Doctor's  abode, 
being  especially  profuse  about  the  corners  of 
the  house  and  fences.  Enterprise,  has  not, 
however,  stopped  here,  and  we  have  occasionally 
added  a  street  lamp,  or  a  huge  grey  stone  slab, 
fashioned  after  the  model  of  a  modern  tomb- 
stone, and  decorated  with  the  Doctor's  name. 

We  don't  know  that  there  is  any  written  law 
on  this  subject,  and  it  is  generally  considered 
simply  a  matter  of  taste,  but,  perhaps,  it  is  well 
to  "  draw  the  line  somewhere,"  and  we  venture 
to  hope  that  the  line  has  been  reached,  if  not 
passed,  in  Toronto,  and  that  no  further  improve- 
ments will  be  attempted. 


ST.  THOMAS  SANITARY  CONVENTION. 

We  direct  the  attention  of  our  readers  to 
the  announcement  in  our  advertising  columns 
of  this  first  Sanitary  Convention  in  Ontario 
under  the  auspices  of  the  newly  created 
Provincial  Board  of  Health.  The  meeting  is 
to  be  held  on  the  19th,  and  20th  inst.,  in  St. 
Thomas,  and  it  is  clearly  the  duty  of  all 
members  of  the  profession  in  whose  power  it 
may  lie,  to  strengthen  and  assist  the  Provincial 
Board  in  its  laudable  efforts  at  the  populariz- 
ation and  diffusion  of  sanitary  knowledge,  by 
adding  alike  their  presence  and  their  strenuous 
personal  endeavours  to  secure  the  success  of 
this  inaugural  convention.  Dimidiam  facti 
habet  qui  bene  conpit. 


THE  F.  R.  C.  P.,  LONDON. 

That  it  is  not  altogether  an  Utopian  expecta- 
tion for  a  Canadian  practitioner  to  aspire  to 
such  proud  eminence  is  fully  demonstrated  by 
the  recent  election  of  Dr.  J.  A.  Grant,  of 
Ottawa,  to  this  honourable  distinction.  At  the 
same  n)eeting  at  which  Dr.  Grant's  election  was 
made,  a  resolution  was  passed  reiter.iting  an 
affii'mation  of  40  years  ago,  to  the  effect,  "That 
the  system  of  extensively  advertising  medical 
works  and  the  custom  of  giving,  whether  for 
publication  or  not,  laudatory  certificates  of 
medicinal  or  other  preparations,  or  of  medical 
or  surgial  appliances  is  misleading  to  the  public, 
derogatory  to  the  dignity  of  the  profession,  and 
contrary  to  the  traditions  and  resolutions  of  the 
Royal  College  of  Physicians."  In  felicitating 
our  fellow  countryman  on  his  attainment  to  this 
enviable  distinction,  we  cannot  refrain  from 
expressing  the  hope  that  he  may  be,  on  all 
occasions  and  in  all  places,  foremost  in  enuncia- 
ting and  exemplifying  the  words  and  spirit  of 
this  resolution  of  his  college ;  for  in.  this 
benighted  province  where  the  lamp  of  ethics  is 
sometimes  threatened  with  obscurity  from  the 
shadow  of  utility  and  gain,  and  there  is  good 
cause  for  "  grieving  that  our  greatest  are  so 
small,"  we  have  sore  need  of  the  clarifying 
influence  of  a  bright  and  eminent  example. 


CHLOROFORM  INHALATION. 

There  is  scarcely  any  doubt  as  to  the  fact 
that  chloroform  is  more  prompt  in  its  action, 
and  more  agreeable  to  inhale  than  any  anaes- 
thetic known,  and  it  is,  therefore,  very  impor- 
tant to  ascertain,  as  far  as  possible,  the  sources 
of  danger  connected  with  its  use.  In  a  recent 
article  on  the  subject  in  the  Medical  and 
Surgical  Reporter,  reference  is  made  to  the 
experiments  of  Dr.  Theo.  Clemens,  which  show 
that  chloroform  is  more  safe  when  recently 
prepared,  and  if  it  has  not  "been  exposed 
to  light.  Its  dangers  lie  in  the  act  of  self- 
decomposition,  which  is  more  apt  to  take  place 
in  old  chloroform  which  has  been  exposed  to 
sunlight.  Clemens  states  that  the  danger  of 
such  self-decomposition  is  removed  by  the 
addition  of  five  i>er  cent,  of  alcohol  to  the 
chloroform. 


OF  MEDICAL  SCIENCE. 


307 


JUBILEE  OF  THE  BRITISH  MEDICAL 
ASSOCIATION. 

The  fiftieth  Annual  Meeting  of  this  Associa- 
tion which  was  held  at  Worcester,  Englaad, 
appears  to  have  been  unusually  interesting  and 
successful.  It  was  a  happy  thought  to  hold 
its  jubilee  in  the  place  of  its  birth,  50  years 
ago.  The  reminiscences  connected  wit'i  the 
first  meeting  held  in  this  old  town,  so  beautifully 
situated  among  the  great  '  Midland  Hills,"  and 
which  have  now  become  matters  of  history,  (the 
attendants  of  the  inaugural  meeting  having  all 
passed  away),  were  exceedingly  interesting 
although  in  some  respects,  of  necessity,  sad. 
"While  this  year,  those  present  had  to  mourn  the 
loss  of  those  noble  men  who  founded  the  Asso- 
ciation, they  could  at  the  same  time  look  back 
with  pride  upon  the  history  of  the  50  years 
of  vigorous  existence  of  the  grandest  Medical 
Society  the  world  has  ever  seen.  Canada, 
fortunately,  had  two  worthy  representatives 
present,  Drs.  W.  T.  Aikins,  and  J.  E.  Graham, 
of  Toronto,  to  the  latter  of  whom  we  are  in- 
debted for  the  able  and  interesting  report  which 
we  are  pleased  to  be  able  to  give  in  this  issue- 


The  Canada  Medical  and  Surgical  Jour- 
nal.— Our  esteemed  Montreal  contemporary 
has  sufiered  a  change  in  the  editorial  depart- 
ment— Dr.  Molson  retiring  on  account  of  Other 
engagements.  Dr.  Molson  was  a  general 
favourite,  and  his  loss  will  be  much  regretted  ; 
but  the  editorial  lacuna  has  been  promptly  and 
ably  filled  by  Dr.  T.  0.  Roddick,  Professor  of 
Clinical  Surgery  in  McGill  University.  We 
trust  that  the  Journal  will  continue  to  improve, 
and  make  as  much  progress  under  the  new 
regime,  as  it  did  under  the  late  new,  which  is 
now  the  old. 


Disinfection  of  Urine. — Dr.  E.  C.  Curtis, 
in  the  Medical  Annals,  says,  that  5  grains  of 
chloral  to  the  ounce  of  urine  preserves  it  per 
fectly  for  microscopic  purposes  for  months. 
This  is  a  matter  of  importance  in  cases  where 
specimens  of  urine  have  to  be  transmitted  to  a 
distance  for  examination. 


PERSONAL. 

Mr.  Spencer  Wells  is  this  year  President  of 
the  Royal  College  of  Surgeons,  of  England. 

Drs.  Rosebrugh  and  Reeve  will  return  from 
the  North- West,  about  September  1st. 

Huge  posters  on  the  fences  again  announce 
a  removal  to  Spadina  Avenue. 

Dr.  Graham,  of  Toronto,  sailed  for  home  on 
the  18th  of  August,  and  resumes  his  practice 
the  1st  of  September. 

Dr.  T.  G.  Holmes,  formerly  of  Brussels,  Dr. 
Rutherford,  of  Chatham,  and  Dr.  Burritt,  of 
Peterboro',  have  moved  to  Toronto. 

Dr.  D.  Clark,  Superintendent  of  the  Tor- 
onto Asylum  for  Insane,  went  to  Winnipeg 
with  the  "  Press  "  excursionists. 

John  G.  Kittson,  M.D.,  McGill,  formerly 
Surgeon  to  the  North-West  Mounted  Police, 
has  settled,  in  practice,  in  St.  Paul,  Minn. 

R.  J.  B.  Howard,  B.A.,  M.D.,  McGill, 
LR.C.P.,  London,  was  admitted  M.R.C.S., 
England,  on  31st  July. 

Von  Bergmann  of  Wurzburg  has  succeeded 
Langenbeck  in  the  Chair  of  Surgery  at  Berlin. 
Volkmann,  of  Halle,  like  Bilroth,  declined  it. 
Dr.  Aikins,  after  attending  the  meeting  of 
the  British  Medical  Association  at  Worcester, 
went  to  the  Continent. 

Dr.  John  Cbiene  has  been  appointed  to  the 
chair  of  surgery  in  Edinburgh,  in  succession  to 
the  late  Prof.  Spence. 

Mr.  W.  F.  Teevan,  of  London,  has  been 
obliged  to  relinquish  the  practice  of  his  pro- 
fession, on  account  of  serious  cardiac  disease. 

Amed^e  Latour,  former  Editor-in-Chief  of 
L' Union  Medicale,  died  at  his  residence,  Cha- 
tillon,  on  the  28th  of  June. 

We  are  glad  to  be  able  to  announce  that 
Dr.  James  Ross,  sen.,  who  has  been  conBned 
to  the  house  with  peritonitis  (localized)  is 
again  able  to  be  about  on  active  duty. 

Dr.  G.  B.  Loring,  of  Massachusetts,  a 
graduate  of  Harvard  in  Arts,  1838,  in  Medi- 
cine, 1842,  has  entered  the  U.S.  Government 
as  Commissioner  in  Agriculture. 

Dr.  Andrew  Buchanan,  late  Professor  of 
Physiology  in  the  University  of  Glasgow,  died 
on  J  uly  2nd,  aged  84.  His  name  is  inseparably 
associated  with  the  rectangular  staff  for  litho- 
tomy which  he  invented. 


308 


CANADIAN  JOURNAL 


Dr.  James  Alex.  Grant,  of  Ottawa,  was 
elected  F.  R.  C.  P.,  on  27th  July.  H.  H. 
Chown,  M.D.,  Kingston  ;  and  H,  W.  Thornton, 
M.  D.  McGill,  and  R.  J.  Bliss  Howard,  B.  A., 
M.  D.,  McGill,  were  admitted  L.  R.  C.  P., 
London,  on  27th  July. 

The  Profossorship  of  Anatomy  at  Harvard, 
was  established  in  1782,  its  first  occu])ant  being 
Dr.  John  Warren,  who  was  succeeded  by  his 
son,  Dr.  John  Collins  Warren,  and  he  in  turn 
in  1847,  by  Dr.  Oliver  Wendell  Holmes,  the 
present  incumbent.  Thus  in  one  hundred 
years  three  men  alone  have  filled  that  chair. 

Mr.  Frank  Maitlaud  Balfour,  lately  elected 
Professor  of  Animal  Morphology  at  Cambridge, 
and  a  distinguished  labourer  in  the  field  of 
Embryology,  was  recently  found  dead,  along 
with  his  Swiss  guide,  on  the  Italian  side  of 
Mont  Blanc.  He  was  only  a  little  over  the 
age  of  30  years. 


OBITUARY. 


Alexander  Greenlees,  M.B.,  one  of  the  most 
respected,  busy,  and  promising  of  the  younger 
generation  of  prcictitioners  in  this  city,  passed 
peacefully  away  on  the  10th  of  August,  amidst 
the  pinewoods  of  Muskoka,  whither  he  had 
gone,  as  he  had  so  often  done  in  summer  time 
before,  to  seek  surcease  of  the  harrassingand 
distressing  symptoms  of  pulmonary  phthisis, 
whose  attack  he  had  for  several  years  manfully 
combatted,  and  whose  victory  he  accepted  with 
Christian  fortitude  and  resignation.  Medicine 
was  not  his  first  vocation  ;  but  when,  as  an 
after-thought,  he  determined  on  that  course, 
he  pursued  it  so  successfully  that,  despite  the 
disadvantage  of  having  had  no  academic  train- 
ing, he  carried  off  the  scholarship  in  every 
year  of  the  curriculum  except  the  first,  and 
graduated  in  the  Faculty  of  Medicine  in  the 
University  of  Toronto  as  gold  medallist  and 
Starr  silver-medallist  in  1870.  A  man  of  the 
highest  probity,  his  straightforward  manner 
impressed  one  favourably  from  the  first ;  and 
being  gifted  with  much  assiduity  in  business, 
together  with  sound  judgment  and  "saving 
common  sense "  he  soon  acquired  a  large  and 
appreciative  clientele.  Indeed  the  writer  can 
aver  that  it  falls  to  the  lot  of  few  practitioners 


to  enjoy  the  esteem  and  confiilence  of  their 
patients  in  such  a  high  degree  as  Alexander 
Greenlees  did.  Soon  after  graduating  he  be- 
came first  tutor  in  chemistry,  and  afterwards 
Lecturer  on  Practical  Chemistry  in  the  Toronto 
School  of  Medicine,  of  which  he  was  an 
alumnus.  At  the  time  of  his  death  he  was 
only  39  years  of  age,  but,  as  Cicero  has  said, 
omni  cetate  mors  est  communis  ;  and  although 
he  was  not  spared  to  reap  the  full  fruition  of 
his  early  ho{)e8  and  just  expectations,  yet  in 
his  day  and  generation  he  served  his  fellow- 
man  faithfully  and  well,  and  thus  inherited  the 
promise.  Dignum  laude  viruvi  Musa  vetat 
mori,  Horace  has  truly  said,  and  daily  experi- 
ence certifies  us  of  the  fact  that  in  the  recollec- 
tion of  his  works  and  words  the  just  man  lives 
again,  "  the  good  man  never  dies." 


ioofe  §0iim. 


Announcement  of  the  College  of  Physicians 
and  Surgeons  of  Ontario,  for  the  Academic  Year 
188283. 


Second  Annual  Announcement  of  the  Col- 
legiate Department  of  the  Minnesota  College 
Hospital,  Minneapolis,  Minn. 


Transactions  of  the  Michigan  State  Medical 
Society  for  the  year  1882.  This  Society  seems 
to  have  a  membership  of  close  upon  250  j  and 
an  active  and  painstaking  Secretary,  Dr.  Geo. 
E.  Ranney,  of  Lansing.  The  transactions  are 
carefully  and  promptly  issued  in  good  and 
pleasing  form,  but,  this  year,  are  somewhat 
disappointing  in  subject  matter. 


Transactions  of  the  Medical  and  Chirurgical 
Faculty  of  the  State  of  Maryland. — 84th 
Annual  Session.  The  transactions  of  the  84th 
annual  meeting  of  this  association  held  in 
Baltimore,  Md.,  in  April  last,  are  now  before 
us.  The  volume  is  well  got  up  and  nicely 
printid  as  befits  the  venerable  age  of  the 
society.  Some  of  the  reports  and  pa])ers  are 
highly  interesting,  and  especially  those  con- 
tributed by  the  Johns-Hopkins  men. 


OF  MEDICAL  SCIENCE. 


•309 


Atlas  of  Gyncecology  and  Obstetrics.     Edited  by 
Dr.  a.  Martin.  Supplemented  by  numerous 
illustrations  from  J.  P.  Maygrier's  Nouvelles 
Demonstrations     D'Accoucliements.    Cincin- 
nati :  A.  E.  Wilde  cfe  Co. 
We  are  in   receipt   of  Part   V.   which   was 
omitted  in  forwarding  this  valuable   work  in 
parts,  the  satisfactory  completion  of  which  we 
noticed  in  our  last.     This  part  covers   a   large 
number  of  pathological  conditions,  and  presents 
the  same  excellence  of  execution  to  which  we 
have  borne  testimony  in  previous  notices. 


What  to  do  in  Cases  of  Poisoning.     By   Wm. 

MuRRELL,  M.D.,  M.R.C.P.     Second  edition. 

Detroit :  G.  S.  Davis,  1882. 

This  valuable  little  compend  of  Murrell's, 
containing  plain,  straightforward,  excellent 
directions  for  the  prompt  treatment  of  cases  of 
poisoning,  arranged  alphabetically,  according  to 
name  of  poison,  thus  made  easy  of  reference, 
and  quite  intelligible,  even  for  laymen,  is  pub- 
lished by  Davis,  of  Detroit,  in  that  compact, 
little  form  well  suited  for  the  vest  pocket, 
4  X  3  X  I  inches.  Every  student  should  carry 
one  with  him,  and  so  should  every  practitioner 
until  long  experience  has  made  him  semper 
paratus  in  emergencies. 


The  Change  of  Life  in  Health  and  Disease.  By 
Edward  John  Tilt,  M.D.,  Past  President 
of  the  Obstetrical  Society  of  London.  Phila- 
delphia :  P.  Blakiston,  Son  tk  Co. 
Speaking,  generally,  there  is  no  doubt  our 
knowledge  of  the  great  importance  of  the 
changes  which  take  place  during  the  climac- 
teric period  are  vague  and  incomplete.  Medical 
men,  along  with  wise  old  women,  are  in  the 
habit  of  attributing  various  ills  to  the  "  change 
of  life ; "  but,  frequently,  in  a  very  indefinite 
and  unscientific  way.  This  work,  which  is 
undoubtedly  the  best  written  on  the  subject, 
will  be  warmly  welcomed  by  the  general  prac- 
titioner. The  author  has  adopted  the  right 
course  by  giving,  first  a  chapter  on  the  physi- 
ology of  the  menopause,  then  the  pathology, 
and,  after  thus  establishing  a  satisfactory  basis, 
goes  on  to  describe  the  diseases  of  the  various 
systems  and  organs  of  the  body  which  may 
arise.  Remember  the  important  fact  that  the 
price  is  only  75  cents  for  the  book,  in  paper ; 
and  $1,25  in  cloth  binding. 


I  The   Illustrated    Quarterly   of  Medicine    and 
\      Surgery.     Edited  by  Drs.  Geo.  Henry  Fox, 
and  Frederick    R.    Sturgis,  with   the  co- 
operation of   Profs.  Willard  Parker,  A.  C. 
\       Post,  W.  H.  Van  Buren,  J.  L.  Little,  T.  G. 
Thomas,  A.  L.  Loomis,  F.  Delafield,  D.  B. 
Sc  John  Roosa,  C.  R.  Agnew,  <k  Austin  Flint, 
New  York  :  E.  B.  Treat,  No.  757  Broadway. 
We  are  in  receipt  of  No.  3,  (July)  of  vol.  1., 
of  this  valuable  publication.     Its  contents  are  : 
Duodenal  Ulcer,  by  F.  W.  Campbell,  Montreal 
(1  illustration) ;  A  New  Method  of  Closing  Ure- 
thral Fistula,  by  Chas.  McBurney,  (14  illustra- 
tions); A  Case  of  Congenital  Keratoma,  by  G.  G. 
Wheelock,  (2  illustrations)  ;  Papilloma  of  Pha- 
rynx Removed  and  Cured  by  John  O.  Roe,  (1 
illustration)  ;  Gummous  Iritis,  two  cases,  by  F. 
R.  Sturgis  (2  illustrations) ;   Therapeutic  Uses 
of  Rubber  Tubing,  by  W.  M.  Chamberlain,  (6 
illustrations)  ;  and  Elastic  Tension  in  the  Treat- 
ment of  Pott's  Disease,  by  M.  J.   Roberts   (8 
illustrations).  Subjects  2,  6,  and  7  are  especially 
noteworthy  by  the  general  practitioner ;  and, 
although    6  contains  nothing  really  new,  yet 
the  hints  for  utilization  of  rubber  tubing  are 
good,  and   it   well    establishes,  not    only    the 
priority,  but  the  superiority  of   its  use  over 
Leiter's  metal  tubes  which  have  lately  attracted 
so  much  trans-atlantic  notice. 


MEETING  OF  THE  BRITISH  MEDICAL 
ASSOCIATION,  AUGUST,  1882. 

The  British  Medical  Association  held  this 
year  its  jubilee  meeting  in  the  place  of  its 
birth,  the  "  faithful  city  "  of  Worcester.  Fifty 
years  ago  the  foundation  stone  of  the  Associa- 
tion was  laid  by  Charles  Hastings,  and  a  small 
but  devoted  band  of  fellow-workers.  Sir 
Charles  Hastings  appears  to  have  been  a  man 
of  unusual  ability  and  industry.  Besides  being 
a  very  successful  practitioner  of  this  city,  he 
was  also  an  excellent  physiologist,  sanitarian, 
and  geologist.  He  was  as  well  a  very  promi- 
nent member  of  the  Association  for  the  Advance- 
ment of  Science.  A  touching  tribu!e  to  his 
memory  was  given  by  his  son,  Mr.  G.  W. 
Hastings,  M.P.,  at  one  of  the  entertainments. 

Your  correspondent,  in  company  with  Dr. 
Aikins,    President   of  the   Toronto  School   of 


310 


CANADIAN  JOURNAL 


Medicine,  had  the  pleasure  of  attending  the 
meetings,  and  of  being  made  members  by  in- 
vitation. 

There  were  between  four  and  five  hundred 
in  attendance.  The  first  day,  Tuesday,  August 
8th,  was  taken  up  largely  by  business  meet- 
ings. In  the  afterncK)n  there  was  a  special 
service  at  the  Cathedral,  and  a  sermon  preached 
by  Lord  Alwjne,  Dean  of  Worcester.  In  the 
evening.  Dr.  Strange,  of  this  city,  the  Presi- 
dent, gave  the  annual  address.  In  speaking 
of  the  foundation  of  the  Society  in  1832  he 
said  : 

"  Both  at  home  and  on  the  continent  of 
Europe  that  decade  was  distinguished  by  a 
galaxy  of  names  the  like  of  which,  at  one 
period  of  time,  the  world  has  rarely,  if  ever, 
seen.  There  were,  indeed,  giants  in  those 
days.  Recall  to  your  minds  the  names  of 
Wilson  Phillip,  wlio  once  lived  here  in  Wor- 
cester ;  of  Lawrence,  ot  Abernethy,  and  of 
Cooper,  all  of  whom,  however,  were  already 
passing  away  ;  and  then  of  Copeland,  of 
Latham,  of  Marshall  Hall,  of  Brodie,  and  of 
Watson,  in  England  ;  of  Barclay,  and  Gregory, 
the  Munroes  and  the  Thompsons,  of  Knox, 
Alison,  Bell,  and  Chriatison,  in  Scotland;  of 
Graves,  and  Stokes,  and  Colles,  and  many 
others,  in  Ireland.  Nor  was  the  Continent  in 
any  way  behind  us.  I  myself  had  the  pleasure 
and  advantage  of  hearing  Louis  expound 
Laennec,  and  of  literally  sitting  at  the  feet  of 
Andral,  Chomel,  Magendie,  Roux,  and  Milne 
Edwards ;  whilst  Rokitanski,  Skoda,  Liebig, 
and,  later,  Virchow,  were  raising  the  German 
School  of  Medical  Philosophy  frum  out  of  its 
backward,  or  at  least,  little  known,  condition, 
towards  the  pitch  of  eminence  to  which  it  has 
since  attained." 

The  President  went  on  to  compare  the  con- 
dition of  the  profession,  and  more  especially  of 
the  provincial  medical  men,  with  that  of  the 
physicians  of  the  present  time,  and  concluded 
an  admirable  address  by  advising  a  closer 
union  between  the  different  branches  of  the 
Association. 

On  Wednesday  morning,  Dr.  W.  F.  Wade, 
of  Birmingham,  delivered  an  address  on  medi- 
cine, before  the  general  assembly  in  the  large 
hall.     He  spoke  of  the  progressive  character  of 


medicine,  and  of  the  manner  in  which  it  over- 
came the  difficulties  and  short-comings  of  the 
past,  stating  in  his  remarks,  that  "in  1820  a 
physician  of  Nottingham,  Marshall  Hall, 
opened  the  first  parallel  of  the  siege  which 
eventuated  in  razing  the  stronghold  of  blood- 
letting." 

In  the  afternoon  the  sectional  meetings  were 
held.  The  Association  was  divided  into  eight 
sections,  Medicine,  Surgery,  Obstetric  Medicine, 
Public  Medicine,  Anatomy  and  Physiology, 
Pathology,  Ophthalmology,  and  Otology.  In 
the  medical  section  a  very  interesting  ])aper 
was  read  by  Dr.  Playfair,  on  "  the  Systematic 
Treatment  of  Aggravated  Hysteria  and  Allied 
Forms  of  Neurasthenic  Disease."  He  strongly 
advised  Weir  Mitchell's  treatment  for  these 
cases,  giving  a  number  in  which  he  himself 
had  been  successful.  He  placed  great  stress 
on  the  importance  of  having  a  thoroughly 
capable  nurse.  In  the  discussion  which  fol- 
lowed there  was  a  universal  endorsation  of  the 
"  massage "  for  appropriate  cases,  care  being 
taken  that  a  correct  diagnosis  is  made.  Where 
organic  disease  is  present  this  method  of  treat- 
ment is  likely  to  do  harm  rather  than  good. 
There  was  some  difference  of  opinion  as  to  the 
extent  to  which  uterine  disease  pro! need  these 
hysterical  conditions,  the  gynsecologists  taking 
one  side,  and  the  neurologists  the  other.  The 
former,  however,  were  free  to  admit  that  ofteu 
the  nervous  state  remained  after  the  uterine 
cause  had  been  removed. 

In  the  obstetric  section  a  paper  was  read  by 
Dr.  Bantock,  of  London,  on  "  hysterectomy." 
He  reported  twenty-one  cases,  in  most  of  which 
he  had  removed  the  uterus  on  account  of 
fibroids.  Of  the  twenty-one  six  died.  In 
three  of  the  latter  the  cause  of  death  had  been 
haemorrhage. 

The  reader  strongly  advised  the  use  of  a 
peculiar  form  of  clamp  of  great  power,  which 
he  exhibited,  and  recommended  that  the  pedicle 
be  allowed  to  remain  in  the  wound.  He  con- 
siders the  greatest  danger  to  be  from  haemorr- 
hage, and  thinks  he  can  in  almost  all  cases  con- 
trol it  by  the  clamp  he  now  uses.  In  the  dis- 
cussion which  followed  some  of  the  members 
were  of  opinion  that  operations  were  too  fre- 
quently performed  for  fibroids.     Many  of  the 


OF  MEDICAL  SCIENCE. 


311 


cases  could  be  cured  by  the  internal  adminis- 
tration of  medicine,  and  in  many  the  presence 
of  the  tumour  did  not  have  any  very  deleterious 
effect.  They  all  agreed,  however,  that  cases 
did  occur  in  which  the  operation  was  neces- 
sary and  justifiable.  Dr.  Bantock  does  not 
use  the  antiseptic  treatment.  His  great  reli- 
ance is  on  absolute  cleanliness. 

In  the  pathological  section  a  paper  was  read 
on  the  Pathology  of  Diabetes,  and  one  on 
"  Changes  which  take  place  in  the  Great  Sym- 
pathetic in  Chronic  Bright's  Disease."  The 
latter  was  illustrated  by  microscopical  sections 
showing  degeneration  of  the  nerve  cells  in  the 
semilunar  ganglia.  Specimens  were  also  ex- 
hibited of  diseases  of  the  spinal  cord,  more 
particularly  the  degenerations. 

On  Thursday  morning  Professor  Stokes,  of 
Dublin,  gave  the  address  on  surgery.  He,  in 
the  first  place,  briefly  reviewed  many  of  the 
more  important  discoveries  made  in  surgical 
science  during  the  last  half  century,  i.e.,  during 
the  existence  of  the  Association.  He  after- 
wards selected  three  which  he  considered  by 
far  the  most  important,  viz.,  (1)  Anaesthetics, 
(2)  Listerism,  and  (3)  Resection  of  Joints  and 
Osteotomy.  He  is  an  ardent  follower  of  Lister, 
and  set  forth  in  a  masterly  way,  the  great  suc- 
cess brought  about  in  surgery  by  that  mode  of 
treatment.  As  a  most  striking  instance  he  gave 
the  hospital  to  which  he  himself  belonged.  The 
building  was  an  old  one  not  originally  intended 
for  a  hospital,  and  without  the  modern  im- 
provements in  ventilation,  &c.  It  was  also 
situated  in  a  very  unhealthy  neighbourhood. 
Formerly  pyaemia,  erysipelas,  and  hospital 
gangrene  were  not  at  all  uncommon,  but  since 
the  adoption  of  the  antiseptic  treatment  not  a 
single  patient,  who  had  been  accurately  treated, 
had  suffered  from  these  diseases.  He  con- 
cluded a  most  eloquent  address  by  an  earnest 
appeal  on  behalf  of  vivisection,  as  a  means  for 
the  advancement  of  surgical  science.  The 
speaker  is  a  worthy  son  of  a  worthy  sire.  His 
father  was  the  celebrated  Dr.  Stokes,  of  Dub- 
lin. It  is  quite  impossible  to  give  any  idea  of 
the  thrilling  eloquence  and  great  beauty  of 
many  parts  of  the  address.  Your  correspond- 
ent can  only  say  that  such  eloquence  and  such 
beauty  of  diction  he   has  never  before   heard 


from  any  member  ot  the  profession,  nor,  in  fact, 
from  any  one  else. 

The  sectional  meetings  took  place  during  the 
afternoon.  In  the  pathological  section,  Mr. 
Jonathan  Hutchinson  read  an  excellent  paper 
on  the  etiology  of  cancer,  using  that  term  in 
its  broadest  sense  as  synonymous  with  malig- 
nant disease.  He  gave  three  causes  :  (1)  Local 
irritation,  (2)  Senility,  (3)  Hereditary  trans- 
mission. Of  the  three  he  considered  the  first 
as  by  far  the  most  important.  He  said  that 
he  had  come  to  the  conclusion  that  all  cancers 
were  at  first  local  iu  their  origin,  and  that  they 
might  afterwards  become  hereditary  in  char- 
acter. H6  inculcated  strongly  the  doctrine  of 
a  pre-cancerous  stage,  saying  that  many  cases 
came  to  him  when  they  were  beyond  hope. 
He  is  of  opinion  that  cancers  of  the  lips  and 
tongue  are,  in  nineteen  out  of  twenty  cases, 
the  result  of  smoking.  He  gave  this  as  the 
reason  for  the  rarity  of  the  disease  in  these 
situations  in  women.  He  also  stated  that  the 
clinical  character  of  a  cancer  depended  largely 
on  the  tissue  from  which  it  originates.  In 
this  way  he  accounted  for  the  diflference  in 
character  between  rodent  ulcer  and  epithelioma 
of  the  lip,  as  one  originated  iu  diSerenb  elements 
of  the  skin  from  that  of  the  other. 

Sir  James  Paget  opened  the  discussion.  He 
was  inclined  to  give  more  importance  to  con- 
stitutional predisposition  than  Mr.  Hutchin- 
son. Mr.  Thin  followed,  giving  his  opinion 
from  the  standpoint  of  the  pathological  histolo- 
gist.  He  agreed  in  the  main  with  Mr. 
Hutchinson.  A  number  of  microscopical  speci- 
mens were  exhibited,  sections  cf  granulation 
in  sponge  grafting  were  shown  ;  also  sections 
of  some  of  the  rarer  forms  of  malignant 
growths. 

In  the  medical  section,  Dr.  Austin  Flint,  of 
New  York,  read  a  paper  on  the  self- limited 
duration  of  pulmonary  disease.  He  reported 
a  number  of  cases  of  phthisis  which  had  been 
restored  to  health  without  special  treatment. 

Dr.  Williams  read  a  paper  on  the  contagion 
of  phthisis,  in  which  he  opposed  the  general 
adoption  of  that  theory.  An  exceedingly  in- 
teresting discussion  followed,  in  which  Drs. 
Bennet,  Balfour,  and  Clifibrd  Albutt,  took 
part.     Most  of  the  speakers  attested   to  the 


312 


CANADIAN  JOURNAL 


genuineness  of  the  bacillus  of  Koch,  and  of  its 
being  j)eculiar  to  tuberculosis,  but  there  was  an 
unwillingness  on  the  part  of  many  to  consider 
these  bacteria  as  the  real  cause  oi  the  disease. 

Dr.  A.  J.  Harrison  then  read  a  pa|)er  on 
primary  endocarditis.  He  thinks  that  both 
endo  and  pericarditis  often  exist  as  primary 
diseases  without  being  diagnosed.  Dr.  Clifford 
Albutt  agreed  with  Dr.  Harrison  in  this  par- 
ticular. 

To-morrow  (Friday)  sectional  meetings  will 
be  held  in  the  morning,  and  the  business  of  the 
Association  will  close. 

The  social  element  of  the  meeting  has  been 
very  prominent.  An  elaborate  programme 
has  been  so  far  carried  out  with  entire  satisfac- 
tion to  all.  No  doubt  the  entertainments  yet 
to  come  will  be  quite  as  delightful  as  those 
already  over.  On  Wednesday  afternoon  a 
luncheon  was  given  in  the  Shire  Hall,  at 
which  the  bust  of  Sir  Charles  Hastings,  the 
founder  of  the  Association,  was  presented  to 
the  Mayor  and  Corporation  of  Worcester.  On 
the  evening  of  the  same  day  the  sacred  oratorio, 
"  The  Creation,"  was  given  in  the  Cathedral. 
I  might  here  state  that  the  Cathedral  which 
has  but  recently  been  restored  is  a  noble 
structure.  The  screen  and  choir  together  with 
the  pulpit,  are  perfect  gems  of  art.  On  this 
(Thursday)  evening  the  annual  dinner  took 
place.  To-morrow  a  garden  party  will  be 
given  by  the  Earl  and  Countess  Beauchamp,  at 
Malvern.  On  Saturday  arrangements  have 
been  made  for  several  excursions ;  one  to 
Stratford-on-Avon,  Warwick,  and  Kenilworth, 
and  another  to  Tintern  Abbey. 

In  one  of  the  business  meetings  there  was  a 
lively  discussion  concerning  the  Medical 
Council.  The  latter  body  appears  to  have 
almost  as  hard  a  time  as  its  analogue  in  our 
country.  Dissatisfaction  was  evinced,  with 
regard  to  its  constitution,  and,  of  course,  with 
regard  to  the  examiners  appointed.  DLscrimin- 
ation  was  said  to  have  been  shown  against 
certain  schools.  Perhaps  we  had  best  be  con- 
tented with  our  Council  in  its  present  state, 
and  be  thankful  that  it  is  no  worse. 

Worcester,  August  18, 1882. 
«  ■♦■  ■ 

Punch's  Medical  Student. — "  What  would 
you  do,  sir,"  asks  Punch,  "  if  you  were  called 
to  see  a  man  who  had  hung  himself  1"  "I 
would  cut  him  down."  "Then  what  would 
you  do  ] "     "I  would  cut  him  up." 


TORONTO  MEDICAL  SOCIETY. 

STATED  MEETING,  JUNE    15,   1882. 

A.  H.  Wright,  B.A.,  M.B.,  Vice-President, 
in  the  chair.  Dr.  Bray,  President  of  the 
Medical  Council,  and  Drs.  Rosebrugh,  Day, 
and  McCargow,  members  of  the  Council,  being 
present,  were  cordially  welcomed  by  the  Vice- 
President. 

Dr.  Zimmerman  showed  a  young  girl  suffer- 
ing from  psoriasis  guttata  and  nummularis.  It 
was  eight  weeks  since  the  disease  began. 

Dr.  Oldright  gave  the  following  facts  in  con- 
nection with  a  case  under  his  care  :  A  lad, 
aged  18,  rather  overgrown,  complained  of  pains 
of  a  rheumatic  character ;  after  ten  days  had 
an  attack  of  pneumonia,  and  a  few  days  later 
an  acute  pleuritis  on  left  side.  Shortly  after- 
wards an  endocardial  murmur  of  a  peculiar 
hissing  character  developed.  The  feet  became 
oedematous,  pulse  irregular,  and  temperature 
varying  from  100°  to  103°.  Urine  gave  re- 
action indicating  coloring  matter  of  bile.  All 
these  symptoms  improved,  but  he  has  become 
sullen,  listless,  not  answering  when  spoken  to. 
Refuses  food,  so  that  recourse  was  had  to  the 
stomach  pump. 

Dr.  Cameron  thought  two  explanations 
might  be  offered  for  the  nervous  symptoms, 
either  oedema  of  the  brain  or  embolism  of  the 
terminal  arteries  of  the  brain. 

Dr.  Oldright  thought  cedema  would  cause 
dilated  pupils  and  some  apopletic  symptoms. 

Dr.  Cameron  reported  a  case  of  popliteal 
aneurysm  in  a  man  aged  50,  under  his  care  at 
the  Toronto  General  Hospital.  The  tumor  was 
first  noticed  last  December,  Has  increased  in 
size  steadily  since ;  impulse  and  bruit  distinct. 
During  the  last  week  treatment  by  flexion 
and  instrumental  compression  alternately  as 
they  could  be  borne,  has  been  tried,  but  with 
only  partial  success.  Dr.  C.  had  proposed  ap- 
plying an  Esmarch  bandage  up  to  the  hip, 
omitting  the  tumor,  but  a  systolic  cardiac  mur 
mur  contraindicated  the  use  of  an  anaesthetic. 
A  second  aneurysm  was  difccovered  in  the 
lower  part  of  the  epigastric  region.  The  in- 
creased blood  pressure  resulting  from  ban- 
daging as  proposed  would  affect  this  abdominal 
aneurysm  injuriously.     There  were,  therefore, 


OF  MEDICAL  SCIENCE. 


313 


but  two   alternatives  remaining,   viz.  :  digital 
compression  and  ligation  of  the  femoral  artery. 

Dr.  McCargow  suggested  the  use  of  the  gal- 
vanic needle. 

Dr.  Macdonald  advocated  Iodide  of  potas- 
sium and  rest. 

Dr.  Oldright  deprecated  such  serious  means 
as  ligation' until  digital  compression  had  been 
fairly  tested,  and  related  a  case  under  his  own 
care  some  years  ago,  of  aneursym  of  the  lower 
part  of  the  femoral  cured  by  digital  compres- 
sion continued  for  eighteen  hours  by  relays  of 
students. 

Dr.  Zimmerman  suggested  passing  a  small 
trocar  through  the  tumor,  and  through  this 
introducing  a  horse  hair  to  be  left  in  situ. 

Dr.  Cameron  then  showed  a  cysto  sarcoma 
of  the  testicle  taken  from  a  man  aged  60.  The 
tumor  was  fluctuating,  though  not  "iransparent. 
On  tapping,  a  quantity  of  hydrocele  fluid, laden 
with  chole&terine  crystals,  was  removed,  which 
became  solid  on  boiling.  The  glands  in  both 
groins  were  enlarged.  The  testicle  was  re- 
moved some  days  ago ;  it  was  adherent  to  the 
tunica  vaginalis  at  many  points.  The  disease 
extended  so  far  up  the  cord  that  it  was  thought 
best  to  ligate  it  en  masse  in  order  to  remove 
as  much  as  possible  of  it.  The  vessels  were  also 
torsioned  separately 

Dr.  Rosebrugh,  Hamilton,  gave  a  short 
account  of  several  ovariotomy  cases  he  had  in 
his  practice  lately. 

The  Society  then  adjourned. 


STATED    MEETING,    JUNE    29,    1882. 

Dr.  George  Wright,  President,  in  the  chair. 

Dr.  Cameron  showed  a  tumor  taken  from 
the  side  of  the  neck  of  a  woman  aged  70. 
Three  years  ago  it  was  as  large  as  a  hen's  egg, 
hard  and  freely  movable,  and  was  thought  to 
be  enchondromatous.  She  refused  to  have  it 
removed.  It  subsequently  became  cystic,  and 
as  the  cysts  ruptured  from  time  to  time,  con- 
siderable haemorrhage  occurred. 

Also  uterus  and  ovaries  from  a  young  girl 
who  died  from  puerperal  fever  in  the  Lying-in- 
Hospital  four  days  after  delivery.  The  labor 
was  natural,  pulse  and  temperature  normal. 
A  few  hours  afterwards  she  had  a  severe  chill, 
and  temperature  rose  rapidly  to  105°.     Quinine 


and  morphia  were  given,  but  temperature 
could  only  be  reduced  to  103°.  She  sank  rap- 
idly. There  was  great  abdominal  distension, 
but  no  tenderness.  Necropsy  showed  well- 
marked  evidence  of  peritoneal  inflammation, 
there  being  a  considerable  quantity  of  sero-puru- 
lent  fluid  in  the  abdominal  cavity.  The  ovaries 
were  much  enlarged  and  suppurating,  and  the 
tubes  blocked  with  pus — the  left  being  more 
so  than  the  right. 

Dr.  Oldright  reported  that  the  boy  whose 
case  he  had  brought  before  the  Society  at  last 
meeting,  began  to  take  food  a  few  days  after- 
wards, spoke  a  little,  but  gradually  sank  and 
died.     No  post-mortem. 

Dr.  King  reported  a  case  of  pernicious  anae- 
mia in  a  woman  who  died  four  months  after 
the  symptoms  first  appeared.  She  complained 
of  nothing  but  debility.  The  pulse  was  usu- 
ally under  100,  and  temperature  somewhat 
elevated,  102^*  being  the  highest  recorded. 
He  thought  that  the  number  of  red  corpuscles 
was  decreased,  but  had  made  no  proper  exami- 
nation of  the  blood. 

Dr.  Cameron  drew  attention  to  the  state- 
ment of  Dr.  Fenwick,  of  London,  that  in 
many  of  these  cases  there  was  degeneration  of 
the  glands  of  the  pyloric  end  of  the  stomach ; 
in  other  cases  disease,  usually  tubercular  or  can- 
cerous, of  the  suprarenal  capsules,  or  Bright's 
disease. 

A  general  conversation  on  the  treatment  of 
anaemia,  and  the  relative  merits  of  the  various 
preparations  of  iron  in  these  cases,  followed. 

Dr.  Riddel  reported  two  cases  of  death  from 
coma.     In  one  there  was  pus  in  the  descending 
horn  of  the  lateral  ventricle,  and  in  the  other 
a  small  clot  in  the  right  parietal  region. 
The  Society  then  adjourned. 


STATED    MEETING    JULY    13,    1882. 

Dr.  George  Wright,  President,  in  the  chair. 

Dr.  Macdonald,  in  the  absence  of  Dr.  Temple, 
showed  a  uterus  in  which  rupture  had  occurred 
during  labor.  The  woman  was  a  primipara, 
unmarried,  aged  26,  healthy.  The  labor  began 
at  2  p.m.  Saturday,  July  8th.  She  was  at 
once  removed  to  the  Hospital.  The  membranes 
were  ruptured  on  her  arrival.  The  pains  were 
of  moderate  strength,  and  at  5  p.m  ,  during  a 


314 


CANADIAN  JOURNAL 


somewhat  more  sevei-e  pain  than  thone  preced- 
ing, she  felt  something  give  way.     The   pains 
ceased,  and    some   hemorrhage  followed,    with 
tenderness  over  the   uterine  tumor.     Collapse 
gradually  developed,  and  was  marked  at  10.30 
p.m.,  when  Dr,  Temple,  who   was  then  sum- 
moned,  arrived.     Hasmorrhage  was    now  pro- 
fuse.    On  examination  a  rent  was  found  in  the 
anterior  wall  of  the  uterus  through   which  the 
hand  passed  easily  into  the  abdominal  cavity- 
Ergot  and  ether  were  given   hypodermatically, 
and  the  long  forceps  applied,  but  they  slipped. 
Ether  was    then    administered    and    delivery 
eflfected  by  turning,  with  some  difl&culty.     The 
uterus  responded  but  slightly   to  the  stimuli 
used.    The  child  was  dead.     The  mother  rallied 
somewhat  after  the   effect    of    the  anaesthetic 
passed  off,  but  she  soon  began  to  sink,  and  died 
the  following  Monday  morning,  37  hours  after 
the  nipture  took  place.      A   large  quantity  of 
the  ergot  (Fl.   Ext.),  Zv.   of  ether  sulph.  and 
brandy  were  given  by  hypodermic  injection,  as 
well  as  a    large  quantity   of  brandy    by     the 
mouth.     The  necropsy  showed  a  ragged  rent  in 
the  anterior  wall  of  the  uterus  7   inches  long, 
extending  from  the  juncture  of  the  cervix  with 
body  on  the  left  side  downwards,   and  to  the 
right  to  the  os  uteri. 

Dr.  Oldright  showed  a  large  fatty  tumor  re- 
moved from  the  forehead  of  a  woman  aged  65. 
Also  a  small  fibroid  polypus  removed  from  the 
uterus  on  account  of  profuse  persistent  hsem- 
orrhage. 

Dr.  McPhedran  reported  a  case  of  railway 

accident. 

Dr.  Macdonald  then  read  a  long  and  inter- 
esting paper  on  menorrhagia  and  metrorrhagia, 
dealing  with  many  of  the  causes  and  treatment. 

A  general  discussion  followed,  in  which  all 
present  took  part. 

After  some  general  business  the  Society  ad- 
journed, not  to  meet  again  till  the  last  Thurs- 
day in  August. 


New  Vaccine  Establishment. — Dr.  E.  L. 
Griffin,  of  Fond  du  Lac,  Wisconsin,  has  re- 
moved his  vaccine  business  to  Chicago,  III., 
(125  State  St.)  and  a  company  has  been  formed 
to  carry  it  on  under  the  name  of  the  National 
Union  Vaccine  Co. 


HURON   MEDICAL   ASSOCIATION. 

The  last  regular  qiiarterly  meeting  of  the 
Huron  Medical  Association  was  held  in 
Clinton,  on  Tuesday,  July  18th,  Dr.  W.  J.  R. 
Holmes  of  Brussels,  president,  in  the  chair. 

The  following  raembei-s  were  present :  Dra. 
Holmes,  Worthington,  McLean,  Taylor,  Hynd- 
man.  Young,  Sloan,  Graham,  Williams, 
Bethune,  and  Stewart. 

Dr.  Young,  of  Londsboro,  showed  a  man, 
aged  51,  who  has  a  malignant  stricture  of  the 
rectum. 

Dr.  Taylor  presented  a  man,  age  55,  who 
has  milial  stenosis  with  commencing  degener- 
ation of  the  heart.  The  organic  heart  changes 
in  this  case  appear  to  have  followed  a 
pneumonia  from  which  he  suffered  about  nine 
months  ago  ;  at  least  there  was  no  physical 
evidence  of  any  valvular  or  mural  changes 
during  the  progress  of  his  pneumonia. 

Dr.  Stewart  exhibited  a  man,  age  35,  who 
has  well  marked  atrophy  of  the  left  scapular 
muscles.  The  case  is  one  of  progressive 
muscular  atrophy  commencing  in  the  muscles 
of  the  left  shoulder.  The  supra  and  infra- 
spinati  seem  almost  entirely  gone.  The  deltoid 
is  slightly  affected.  The  disease  is  of  two 
years  standing.  Lately  he  has  had  considerable 
pain  about  the  right  shoulder,  but  up  to  the 
present  there  is  no  wasting  of  any  of  the 
muscles  in  its  neighborhood.  The  atrophied 
muscles,  and  in  fact  nearly  all  the  voluntary 
both  upper  and  lower  extremities  are  the  seat 
of  fibrillary  twitchings  when  percussed. 

The  treatment  pui-sued  in  this  case  is  the 
use  of  the  Faradic  current  directly  to  the 
atrophied  muscles.  It  has  not  as  yet  been 
used  sufficiently  long  to  say  whether  it  is  going 
to  do  any  good  or  not. 

Dr.  Graham,  of  Brussels,  related  the  parti- 
culars of  a  remarkable  case  which  he  recently 
saw.     The  patient  is  a  girl   aged  12.     During 
her  waking   hours   she   only   breathes   six  or 
1  seven  times  a  minute.     With  each  inspiration 
1  the  epigastrium  sinks  in,  and  the  shoulders  are 
drawn  upwards   and    forwards  very    forcibly. 
She  has  been  breathing  in  this  manner  for  six 
months.     Sometime  previously  she  was  said  to 
have  had  inflammation   of  the  lungs.     She  is 
said    to  breathe  naturally   during  sleep.     She 
is  otherwise  perfectly  healthy. 


OF  MEDICAL  SCIENCE. 


315 


pisaUatttouisi. 


Simple  Method  of  Counting  Rapid  Pulse, 

Dr.  A.  W.  Abbott,  of  Minneapolis,   advises 

in  the  New  York  Medical  Record  the  following 
simple  method  of  counting  a  pulse  too  rapid  to 
be  taken  in  the  ordinary  way  :  "  During  a 
definite  part  of  a  minute,  one- fourth  usually, 
with  a  common  lead  pencil  dots  are  made  upon 
a  sheet  of  paper  synchronous  with  the  heart 
heats,  as  heard  over  the  cardiac  region.  The 
dots  are  then  counted,  and  the  number  calcu- 
lated for  the  whole  minute." 

Diagnosis  of  Uterine  Disease  by  the 
Laryngoscope. — Dr.  Seller  was  consulted  by  a 
young  girl  with  general  relaxation  of  the 
mucous  membrane  of  the  throat,  which  he 
concluded  to  be  due  to  uterine  disease,  for 
wh  ch  he  advised  her  to  put  herself  under  the 
tn-atment  of  her  family  physician,  as  local 
treatment  of  the  throat  would  be  of  no  use  to 
her.  Her  reply  was  :  "  Doctor,  if  I  had  known 
tlmt  3  ou  could  see  all  the  way  down  I  would 
not  have  come  to  you." — Maryland  Med.  Jour. 

To  Test  for  Iodine  in  the  Urine — After 
dre.ssing  wounds  freely  with  iodoform,  iodine 
frequently  appears  in  the  urine.  The  Bulletin 
Generale  de  Therapeutique  gives  the  following 
simple  test :  A  little  chloroform  is  added  to 
the  susp-cted  urine  in  a  test  tube.  One  or  two 
drops  of  nitric  acid  are  added  and  the  mixture 
shaken.  Iodine  will  be  set  free,  and  dissolve 
in  the  chloroform,  and  be  found  in  the  bottom 
of  the  test  tube,  presenting  a  beautiful  violet 
colour. — N.  Carolina  Med.  Jou*. 


Pomade  in  Comedo, —  Unna. — Kaolin,  four 
parts ;  glycerine,  three  parts  ;  acetic  acid,  two 
parts.  Mix  with  or  without  a  small  quantity 
of  etherized  oil — apply  the  ointment  every 
evening,  and  even  during  the  day,  keeping  the 
eyes  closed  during  the  inunction.  In  a  few  days 
the  comedines  will  be  easily  expelled,  most  of 
them  by  simple  soap  and  pumice  stone  frictions. 
The  same  results  may  be  obtained  by  long- 
continued  paintings  with  vinegar,  lemon  juice, 
or  dilute  hydrochloric  acid — U  Union  Med. 


Intestinal  Obstruction  relieved  by  Mas- 
sage.— Dr.  Bitterlin  reports  a  case  of  intestinal 
occlusion  accompanied  with  much  pain,  vomit- 
ing of  fecaloid  matter,  hiccough  continuing  in 
spite  of  treatment  for  eight  days,  finally  relieved 
by  kneading  and  malaxation  of  the  belly.  The 
manipulation  was  very  painful.  Some  instants 
after,  violent  colic  came  on  and  gurglings,  the 
bowels  shortly  afterwards  moved  and  the  pa- 
tient recovered.  Dr.  BUterlin  mentions  a 
second  case  in  which  he  was  called  in  consulta- 
tion, where  the  same  treatment  was  followed 
hy  the  same  happy  results. — L' Union  Medical. 

M,  Littr^  found  rest,  of  a  sort,  in  Comtism  ; 
Charles  Darwin  found  rest  in  the  faith  of 
nature's  God  ;  not  the  inner,  reflected,  recept 
of  the  Deity,  which  M.  Pasteur  described  as 
the  "  enthusiasm  " — or  God  within, — but  the 
Unknown,  because  undiscovered,  God  the  cauae 
and  Creator,  which  the  temple  of  Nature,  as 
Darwin  saw  and  worshipped  in  it,  denotes  and 
requires,  wherein  the  innermost  and  most 
mysterious  chamber  is  filled  with  a  cloud  that 
veils  and  yet  reveals  the  Presence  towards 
which  the  human  consciousness  in  its  abiding 
sense  of  incompletness  yearns.  No  more 
wonderful  and  inexplicable  fact  has  challenged 
the  scrutiny  of  thoughtful  minds  during  the 
last  twenty  years  than  the  failure  to  recognize 
that  the  postulate  of  evolution  is  creation. 
Ex  nihilo  nihil  Jit,  or  if  any  one  regards  that  as 
a  mere  platitude,  he  cannot  deny  that  to  evolve 
any  organism,  however  simple,  from  matter 
which  has  not  previously  been  organized,  is 
impossible.  The  primaeval  germ  of  nature  is  a 
necessity  of  the  hypothesis  of  evolution, 
Charles  Darwin  felt  this  to  be  the  fact,  and  he 
was  not  an  Atheist,  a  Materialist,  or  an 
Unbeliever. — London  Lancet. 


A  SHORT  time  ago  Miss  Frances  Power 
Cobbe,  who  has  so  identified  herself  with  the 
cause  of  anti- vivisection,  called  on  a  dis- 
tingiiished  man  of  science  in  London  to  en- 
deavor by  persuasive  speech  and  viva  voce 
argument  to  gain  him  over  to  her  cause.  Three 
points  were  observable  in  Miss  Cobbe's  outward 
presentment,  namely,  she  had  an  ostrich 
feather  in  her  bonnet,  a   bird  of  paradise  on  or 


316 


CANADIAN  JOURNAL  OF  MKDICAL  SCIENCE. 


near  her  muff,  and  she  carried  an  ivory  handled 
umbrella.  Consequently  the  distinguished  man 
of  science  replied  as  follows :  "  Madam, 
charity  begins  at  home.  When  you  have  given 
up  wearing  ostrich  feathers,  which  are  plucked 
from  the  living  bird,  causing  the  most  exquisite 
pain  ;  and  birds  of  paradise,  which,  in  order 
to  enhance  their  beauty  and  lustre,  are 
skinned  alive ;  when  you  have  abjured  the  use 
of  ivory,  because  y%ii  know  that  the  tusks  are 
cut  out  of  the  dying  elephant's  jaw — then,  and 
then  only,  come  and  upbraid  me  with  the 
cruelty  of  my  operations.  The  difference  be- 
tween us  is,  madam,  that  I  inflict  pain  in  the 
pursuit  of  knowledge  and  for  the  ultimate  ben- 
efit of  my  fellow  creatures,  you  cause  cruelty 
to  be  inflicted  merely  for  your  personal  adorn- 
ment."— American  Medical  Weelly. 


THE    USE   OF   NARCOTICS   AND  THE 
QUESTION  OF  RESPONSIBILITY. 

The  miserable  but  just  fate  of  Lamson  will 
not  be  altogether  without  its  use  if  it  con- 
vinces people  who  play  with  narcotics,  whether 
alcohol  or  morphia,  that  they  do  so  on  their 
own  responsibility.  We  may  acknowledge  the 
kindness  of  those  who  sought  to  found  an 
argument  for  change  of  sentence  on  the  abuse 
of  morphia,  but  we  cannot  admire  their 
wisdom.  Where  is  such  a  doctrine  to  endl 
If  it  is  to  be  accepted  the  law  must  take  im- 
mediate charge  of  the  thousands  of  people  who 
are  muddling  their  heads  all  day  long  with 
one  poison  or  another — cocculus  indicus,  alco- 
hol, morphia,  bromides,  chloral,  and  absinthe. 
The  State  will  not  at  present  forcibly  compel 
the  most  incorrigible  drunkard  to  abstain. 
Even  some  bishops  prefer  freedom  to  sobriety 
—  if  one  can  speak  soberly  of  the  freedom  of  an 
habitual  drunkard.  The  clear  doctrine  for  the 
present  is — first,  that  men  who  use  such  things 
aie  responsible  for  using  them,  and  for  all  that 
follows  on  their  use;  and,  secondly,  that  in 
u&ing  them,  the  most  predominant  quality 
manifested  is  that  of  selfishness — a  determina- 
tion to  have  their  sensations  gratified,  or  their 
miseries  drowned  by  what  they  know  injures 
and  impoverishes  them,  and  all  belonging  to 
them. — Londmi  Lancet. 


Ripe  and  Healthy  Ol»  Age. — Gaillard$' 
Medical  Journal:  A.  Bronson  Alcott  has 
written  all  his  poems  since  his  eightieth  birth- 
day. Von  Ranke;  now  eighty-six  yeai-s  of  age, 
is  writing  his  "  History  of  the  World."  Whit- 
tier,  over  seventy,  writes  most  of  the  motning, 
walks  most  of  the  afternoon,  and  often  goes  to  a 
party  in  the  evening.  Longfellow,  over  seven- 
ty-five, read  diligently,  and  collected  material 
for  future  works  !  Oliver  Wendell  Holmes, 
over  sixty,  is  bright,  cheery,  physically  active, 
and  mentally  as  strong  and  uprightly  as  ever. 
Walt  Whitman,  nearly  sixty-four,  the  carpen- 
ter, printer  and  poet,  the  author  of  The  Leaves 
of  Grass,  Drum  Taps,  and  The  Two  Rixndets, 
is  hard  at  work.  Humboldt  commenced  the 
study  of  Hebrew  at  eighty.  Victor  Hugo,  over 
eighty,  is  actively  at  work.  Velpeau,  clinician, 
teacher,  practitioner,  pathologist,  working  ten 
hours  daily,  made  the  time  wherein  to  write 
and  publish  over  eighty  works,  and  died  in 
harness.  Von  Graefe,  whose  clinic  always 
lasted  most  of  the  day  and  on  his  practice  far 
into  the  night,  recorded  his  work  every  day. 
Sir  James  Y.  Sirappon,  from  whose  doors  the 
carriages  of  the  nobility  were  turned  away 
frequently,  after  vainly  waiting  to  bring  their 
occupants  to  the  Doctor's  door,  wrote  volumin- 
ously, held  a  daily  Hospital  Clinic,  and  lectured 
for  an  hour,  three  times  weekly,  etc.,  etc.,  and 
died  in  the  midst  of  sixch  labors,  and  yet  many 
physicians,  but  little  over  fifty,  say  that  they 
are  too  old  to  write,  and  are  getting  too  old 
even  to  read.  And  many  young  men  are  too 
busy  to  write ! ! 


On  Saturday,  the  19th  inst. ,  at  169  Jarvis  Street,  by 
the  Rev.  A.  H.  Baldwin,  Henry  Going,  M.D.,  to 
Frances  Mary,  daughter  of  the  late  Rev.  D.  E.  Blake, 
rector  of  Thornhill. 

On  the  9th  August,  at  tlie  Central  Presbyterian 
Church,  Gait,  by  the  Rev.  J.  A.  R.  Dixon,  .T.  H.  Rad- 
ford, M.D.,  C.M.,  of  Gait,  to  Mary,  ehlest  daugliter  of 
the  late  J.  R.  Philip,  M.D.,  M.R  C.S.,  England. 

At  Glencairn,  Queenston,  on  the  9th  August,  by  the 
Rev.  Stewart  Houston,  R.  J.  Trimble,  Esq.,  M.D., 
L.  R.  C.  P.,  M.R.  C.S.Ed.,  &c.,  to  Maude  Stuart, 
fifth  daughter  of  the  late  W.  A.  Thomson,  Esq 

At  All  Saints'  Church,  Whitby,  on  August  17th,  by 
the  Rev.  —Fiddler,  Dr.  P.  H.  Bryce,  M.A.,  L.R.C.P. 
and  S.,  Edinburgh,  Secretary  of  the  Provincial  Board 
of  Health,  Toronto,  to  Kate  Lynde,  second  daughter 
of  William  Pardon,  Esq.,  Whitby.     No  cards. 

At  the  residence  of  the  bride's  father,  339  Church 
Street,  Toronto,  by  the  Rev.  John  M.  King,  M.A., 
D.D.,JohnFetguson,  M.A.,  M.D.,  L.H.C.P.S.,  Edin., 
to  Sarah  Helen,  eldest  daughter  of  William  M.  Baird, 
Esq.     All  of  Toronto. 


THE 


^ 


"1 


Canabian  |0ttntal  of  ^efeal  ^tmt 

A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


U.  OGDEN,  M.D., 

R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond., 


{■  Consulting  Editors. 


A.  H.  WRIGHT,  B.A.,  M.B.,  M.R.C.S.,  Eng., )  j^^,., 
I.  H.  CAMERON,  M.B.,  > 


SUB8CRIPTIOIV,   $3    PER   ANIVUm. 


SST  All  literary  oommnnications  and  Exchanges  should  be  addressed  to  Dr.  CAMSROK,  278  Sherbotumo    St. , 

iS"  All  business  oommunioations  and  remittanoes  should  be  addressed  to  Dr.  WRIGHT,   20  Gerrard  Street 
Sast. 


TORONTO,  OCTOBER,  1882. 


REPORT  ON  SURGERY. 

(Read  before  the  Canada  Medical  Assoc'n,  Sept.,  1882.) 
BY  FRANCIS  J.  SHEPHERD,  M.D.,  CM.,  M.R.C.S,,  ENG. 

Demonstrator  of  Anatomy,  and  Lecturer  on  Operative  and  Minor 

Surgery,  McGill  University  ;  Surjjeon'  to  Out-Patient 

Department,  Montreal  General  Hospital. 

Mr.  President  and  Gentlemen, — I  do  not 
propose  in  this  report  to  give  an  account  of  all 
the  advances  and  discoveries  made  in  surgery 
during  the  last  twelve  months,  because  I  know 
from  experience  how  tiresome  and  uninter- 
esting such  a  recital  of  facts  is.  My  intention 
is  to  touch  on  some  of  the  more  important  and 
interesting  points,  so  that  they  may  serve  as 
texts  which  may  be  elaborated  in  the  discus- 
sion I  hope  will  be  aroused.  The  subjects  I 
shall  glance  at  will  be  as  follows  : — (1)  Treat- 
ment of  Wounds ;  (2)  Cause  of  Inflammation ; 

(3)  Sponge  Grafting  and  Bone  Transplantation  ; 

(4)  Surgery  of  the  Kidney  ;  (5)  Treatment  of 
Club-foot  3  (6)  Surgery  of  the  Joints,  The 
list  looks  a  formidable  one,  but  remember  that 
I  only  intend  to  furnish  the  texts,  the  sermons 
belonging  to  which  I  hope  you  yourselves  will 
preach. 

T/ie  Treatment  of  Wounds. — Within  the  last 
few  years  this  subject  has  more  than  ever  occu- 
pied the  attention  of  surgeons,  and  has  caused 
many  acrimonious  discussions.  Old  methods 
of  treatment  have  been  wholly  discarded  and 
new  methods  introduced,  of  greater  or  less 
value.  Some  of  these  are  being  constantly 
improved  and  modified,  others  flourish  for  a 
time^  but  when  the  aun  of  experience  is  turned 


on  them,  like  the  seeds  which  fell  on  stony 
ground,  they  are  scorched  and  wither  away. 
At  the  present  time,  all  methods,  however 
much  they  differ  in  detail,  aim  at  keeping 
wounds  aseptic,  and  are  in  fact  antiseptic 
methods  of  treatment.  Listerism  is  only  a 
phase  of  antisepticism,  and  does  not  differ  as 
much  from  other  methods  as  one  would  at  first 
sight  imagine.  The  great  difference  consists  in 
the  more  gorgeous  ritual  and  its  obscuration  by 
the  clouds  of  incense  (in  the  form  of  carbolic 
spray)  which  ascend  heavenward  as  a  pro- 
pitiatory sacrifice  to  the  great  -^sculapius. 
The  fundamental  principles  are,  however,  the 
same,  viz.  :  cleanliness,  asepticity,  rest,  sup- 
port, and  the  accurate  adjustment  of  cut  sur- 
faces ;  and  to  Mr.  Lister  principally  we  owe  the 
universal  recognition  of  the  truth  of  these 
principles.  He,  in  fact,  by  dwelling  on  their 
importance  and  evidencing  their  truth  by  the 
success  of  his  own  practice,  has  revolutionized 
the  surgical  treatment  of  wounds.  He  has 
shown  that  suppuration  and  the  septic  condi- 
tion it  leads  to  may  be  prevented.  He  has 
taught  surgeons  the  necessity  of  thoroughly 
cleansing  and  disinfecting  their  instruments 
and  hands  before  operation.  At  the  Interna- 
tional Congress  held  in  London,  the  subject  of 
the  treatment  of  wounds  was  one  of  the  most 
important  that  engaged  the  attention  of  the 
surgical  section.  From  the  papers  read  and 
the  discussion  which  followed  their  reading,  it 
was  easily  seen  that  the  belief  in  the  carbolic 
spray  was  on  the  wane,  and  that  it  was  desir- 
able that  some  form  of  dressing  less  compli- 
cated than  Listerism  should  be  employed.  Mr. 
Lister  himself  spoke  in  qualified  terms  of  the 
spray,  and  hoped   at  some   future   time  to  be 


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able  to  say  '■^  fori  mil  dim  Sftray."     Professor 
Eamarch's  wonderful  statistics  aided  greatly  in 
confirming    the    confidence    of     surgeons     in 
rest,  support,  and  infrequent  dressings.     Much 
evidence     was     ofi'ered,    and     many    opinions 
were  given  which  supported  the  views  of  Mr. 
Sampson  Gamgee  as  to  a  dry  form  of  antiseptic 
dressing.     Since  the  Congress  the  dry  method 
of  treating  wounds   with   infrequent  dressings 
has  made  wonderful   strides,   and   bids  fair  to 
supplant   Listerism    as   a  form    of    antiseptic 
treatment.     Under  dry  dressings,  wounds  heal 
much  more  rapidly  than  under  moist  warmth, 
which     encourages     putrefaction.       Iodoform 
dressings   have    been   most   generally  used  in 
Germany,  but  so  recklessly  that  many  cases  of 
poisoning  from   it   have  been    recorded.       As 
much  as  7  to  8  ounces  have  been  stufi'ed  into  ab- 
scesses and  excised  joints  at  one  time.     No  case 
of  poisoning  has  been  reported  from  Germany 
where  less  than  3   drachms  was  used.     Whei'- 
ever  possible  I  have  employed  the  dry  form  of 
dressing,   and    I    think    with    success.       My 
method  of  dressing  a  fresh  wound  (for  which  I 
claim  no- originality)   is  as  follows:  After  all 
bleeding  has  stopped,  and  the  wound  has  been 
accurately  closed  by  cat-gut  ligatures,  and  when 
necessary  by  wire  ones  in  addition,   I  sprinkle 
over  the   wound  a  little  iodoform,   cover  this 
with  a  strip  of  oil  silk  (to  prevent  adherence  of 
the  wool),  and  then   over   all   place   a   pad   of 
boracic  cotton.     This  is  kept   in   place   by  an 
accurately  adjusted  gauze  bandage,  which  must 
be  evenly  and  firmly  applied,  so  as  to  get  the 
amount  of  elastic  pressure  required.     If  necep- 
sary,  as  in  a  limb,  a  paste-board  or  other  light 
splint  (well  padded)  is  applied.     If  the  parts 
can     be     accurately     adjusted     by     pressure 
drainage  is  not  required.      The  wound,  if  the 
patient  complains    of   no   discomfort,    should 
not    be    disturbed     for     a     week     or     more. 
When  the  dressing  is  taken  down,    the   wound 
is  generally  found  to  be  nearly  or  quite  healed. 
In  foul  ulcers,  this  method  I  have  found   supe- 
rior to  every  other.     In  some  cases  of  accident, 
where  the  tissue  is  lost,  or  so  much  injured  as 
to  be  beyond  rejiair,  I  have  generally  employed 
the  moist  form  of  dressing  till  the  slough  has 
separated.     Of  late  I  have  been  using  a  solu- 
tion of  boroglyceride,  as  recommended  by  Mr.  I 


Harwell.  This  antiseptic,  as  far  as  my  exi)eri- 
ence  goes,  is  superior  to  carbolic  acid.  It  has 
no  odour,  and  is  perfectly  innocuous. 

With  regard  to   Inflammation,   and   its  con- 
nection with  septic  organisms.    The  theory  that 
you  are  no  doubt  most  familiar  with  is  that 
inflammation  is  due  to  the   introduction  of  at- 
mospheric germs  into  damaged  tissue,  and  that 
if  this  introduction  be  prevented,   the  wound 
heals   without    inflammation.       Prof.    Hueter, 
Mr.   Lister,  Mr.    Watson  Cheyne,  and  others, 
have  been  the  most  able  and  efficient  advocates 
of  this  view.     There  is,  however,  another,  and 
I  think  a  more  probable   explanation   of  the 
origin  and  spread  of  inflammation,    of   which 
Dr.  Burdon  Sanderson  has  lately  in  his  Lum- 
leian  Lectures   given  a  clear   and   convincing 
account,  viz.,  that  "inflammation  is  the  physio- 
logical  effect  of  traumatism  " ;  that  the   exu- 
dates of  a  normal  inflammation  are   not   infec- 
tive; that  no  inflammation  producing  organisms 
exist  in  the  atmosphere ;  that  whenever  inflam- 
mation becomes  infective  it  owes  that  property 
to   chemical  change  in  the  exudation    liquid 
which,  in  absence  of  any  other  better  explana, 
tion,   we  attribute    to  the   presence  of  septic 
organisms  or    bacteria     or,   in   other    words, 
exudative     fluids  which     are     infective    owe 
that  property  to  the   exudative  soil  in  which 
the  germs  grow,   and   that  atmospheric   germs 
are  not  per  se  a  source  of  danger.     Dx'.  San- 
derson says    these   germs    are    not    so    much 
mischief-makers    as    mischief- spreaders — they 
have  the  power  of  developing  what  he  calls  a 
phlogogenic  infection,   and  of  conveying  it  to 
all  parts  of  the   body.     I   do  not  propose  to 
discuss  this  question,  but  merely  place  it  before 
you  as  a  subject  for  discussion,   in   its    bearing 
on  antiseptic  surgery.       Before  passing  on  to 
another  subject,  I  should  like  to  draw  your 
attention  to  some  recent  experiments  by   Dr. 
D.  J.  Hamilton  on  Sponge  Grafting,  and  their 
bearing  on  surgery.     Dr.  Hamilton  some  years 
ago  showed  that  the  vessels  of  a   granulating 
surface  are  not  newly  formed,   but  are  simply 
the  superficial  capillaries  of  the  part  that  have 
become  displaced  :  that  the  granulation  loops 
are  thrown  up  by  rhe  propelling  action  of  the 
heart.     Whilst  pursuing  these  investigations, 
Mr.  Hamilton  was  struck   with   the  similarity 


OF  MEDICAL  SCIENCE. 


319 


of  the  process  of  vascularization,  as  seen  on  a 
granulating  surface,  and  that  which  occurs 
when  blood-clot  or  fibrinous  exudation  is  re- 
placed by  vascular  cicatricial  tissue.  He  states 
that  blood-clot  or  fibrinous  lymph  plays  merely 
a  mechanical  and  passive  part  in  any  situation, 
and  that  vascularization  is  n^t  due  to  the  for- 
mation of  new  vessels,  but  rather  to  a  dis- 
placement and  pushing  inwards  of  the  blood- 
vessels of  the  surroundinof  tissues.  He  looks 
upon  blood-clot  and  fibrinous  exudation  as  so 
much  dead  matter,  which  afibrds  merely  a 
framework  for  the  capillaries  to  ramify  in,  and 
proves  that  it  is  so  by  employing  sponge  to 
replace  it.  This  sponge  is  prepared  in  a  spe- 
cial way,  and  when  placed  on  old  ulcers  he 
succeeded  in  organizing  it — or  rather  filling  its 
interstices  with  blood-vessels  and  cicatricial  tis- 
sue, the  sponge  in  the  meantime  disappearing  by 
absorption.  Many  other  experiments  were 
made  which  fully  proved  his  theory.  Dr. 
Hamilton  noted  a  significant  phenomenon, 
supporting  the  theory  that  blood-vessels  were 
pushed  into  the  sponge  in  loops,  when  the  con- 
vexity of  a  loop  came  in  contact  with  the 
sponge  framework,  instead  of  one  of  its  pores, 
a  curvature  formed  on  the  vessel  at  the  oppo- 
sing point,  and  on  each  side  of  the  obstacle 
there  was  pushed  a  secondary  loop  similar  to 
that  from  which  both  had  arisen.  These  blood- 
vessels, according  to  Mr.  H.,  bear  with  them 
great  numbers  of  the  actively  proliferating  con- 
nective tissue  corpuscles  from  neighboring  con- 
nective tissue,  and  these,  and  not  the  leucocytes, 
are  the  tissue-forming  cells.  Sponge  Grafting, 
he  sayg,  is  excellently  suited  for  growing  new 
tissue  where  that  is  insufficient  to  cover  a 
part.  Instead  of  sponge,  charcoal  or  calcined 
bone  might  be  employed  in  certain  cases,  as, 
for  instance,  where  the  formation  of  new  bone 
is  needed. 

The  Transplantation  of  Bone  has  been  success- 
fully accomplished  both  by  Dr.  MacEwen,  of 
Glasgow,  and  Mr.  McNamara,  of  Westminster 
Hospital,  London.  They  had  been  pursuing 
their  investigations  on  this  subject  at  the  same 
time,  unknown  to  one  another.  Dr.  MacEwen 
placed  his  case  first  before  the  public.  He  re- 
made a  humerus  which  had  been  destroyed  by 
necrosis,   by   placing   small   fragments  of  bone 


(removed  from  patients  with  curved  tibiae)  in  a 
groove  made  in  the  soft  tissues  in  the  position 
of  the  humerus.  Mr,  McNamara  successfully 
replaced  a  tibia  which  had  become  deficient 
from  acute  necrosis.  He  used  portions  of  bone 
from  an  amputated  metatarsus.  The  necessity 
for  transplanting  bone  is  necessarily  rare,  as 
nature  is  so  skilful  in  the  repair  of  bone,  that 
the  interference  of  the  surgeon  is  seldom 
needed.  These  experiments  carry  out  Mr. 
Hamilton's  theory  of  organization,  and  are  in- 
teresting from  a  surgical  point  of  view. 

The  surgeon  looks  upon  no  organ  or  region 
now  as  sacied.  Operations  are  at  present  daily 
performed  successfully  which,  if  even  suggested 
a  few  years  ago,  the  suggester  would  have  been 
looked  upon  as  mad.  The  lung  has  been  par- 
tially excised,  the  liver  has  been  cut  into,  and 
parts  of  it  removed  successfully.  The  whole 
stomach  has  been  excised,  and  the  oesophagus 
stitched  to  the  duodenum,  and  many  feet  of 
intestines  have  been  taken  away,  and  the  cut 
ends  stitched  together,  patients  making  good 
recoveries.  The  renewed  attempts  at  removal 
of  the  spleen  have  not  been  so  successful  as  of 
old,  but  the  whole  uterus  has  been  excised, 
even  when  pregnant,  and  the  patient  has  sur- 
vived, but  this  now  belongs  to  the  realm  of 
gynaecology.  The  surgery  of  the  organ  which 
I  am  going  to  notice  has,  as  yet,  escaped  the 
upward  tendency  of  the  gynaecologist,  but  how 
long  it  will  remain  in  the  domain  of  pure  sur- 
gery I  know  not,  as  already  one  of  its  depen- 
dencies (the  bladder)  has  been  annexed  in  the 
female. 

The  Surgery  of  the  Kidney  has  greatly  en- 
gaged the  attention  of  surgeons  during  the  last 
twelve  months.  At  the  International  Congress 
it  was  the  subject  of  several  papers,  and  caused 
much  interesting  discussion.  Since  then  it  has 
occupied  considerable  space  in  the  Medical 
Journals,  and  the  operations  of  nephro-litho- 
tomy;  nephrotomy,  and  nephrectomy  have  be- 
come recognized  operations.  It  has  been  estab- 
lished beyond  doubt  that  nephro-lithotomy  is  a 
most  successful  operation  in  properly  selected 
oases,  viz.,  where  the  stone  is  of  moderate  size 
and  single,  and  the  kidney  has  not  become  dis- 
organized. It  is  a  most  scientific  procedure  to 
perform   this  operation  where  stone  has  been 


330 


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certainly  diagnosed  by  needle  exploration,  oi 
where  the  pain  and  other  symptoms  lead  one  to 
believe  there  is  »  stone  present.  If  left,  the 
stone  is  certain  to  disorganize  the  kidney,  cause 
much  suffering,  and  probably  death.  The 
operation  of  incising  the  kidney  (nej)hrotomi/) 
has  not  proved  a  dangerous  one,  and  it  has 
been  frequently  demonstrated  that  the  kidney 
can  be  easily  explored  through  a  lumbar  in- 
cision, and  even  cut  into  with  great  safety.  In 
cases  of  strumous  or  calculous  pyelitis,  the  sac- 
culated kidney  can  be  drained  through  a  wound 
in  the  loin  and  the  patient  freed  from  the 
danger  and  pain  of  retained  matter.  Nephro- 
tomy, as  an  operation,  is  merely  palliative,  and, 
nephrectomy,  or  removal  of  the  kidney,  is  a 
much  more  formidable  operation  than  the  fore- 
going. The  dangers  are  greater,  and  many 
cases  have  been  followed  by  suppression  of 
urine.  It  has  also  proved  fatal  from  haemor- 
rhage, and  wounds  of  neighbouring  organs,  as 
lung  and  pleurse.  As  yet  it  has  not  been 
positively  determined  in  what  cases,  or  at  what 
period,  it  should  be  perfotmed.  It  has  been 
done  for  tumour,  cancerous  diseases,  and 
strumous  and  calculous  pyelitis.  It  is  a 
question  whether  before  nephrectomy  is  per- 
formed, a  preliminary  nephrotomy  should  not 
be  tried.  Now  the  loin  is  the  most  favourable 
position  for  nephrotomy  and,  perhaps,  the  most 
difficult  incision  for  nephrectomy,  so  this  would 
be  an  objection.  Some  hold  that  if  a  prelim- 
inary nephrotomy  is  performed,  it  much  in- 
creases the  difficulty  of  a  subsequent  nephrec- 
tomy. Again,  it  is  important,  in  considering 
the  advisability  of  performing  nephrectomy,  to 
find  out  whether  tlie  pyelitis  is  confined  to  one 
kidney,  or,  rather,  whether  the  other  kidney  is 
healthy.  Strumous  pyelitis  is  rarely  confined 
to  one  kidney,  and,  therefore,  excision  of  the 
kidney  must  be  a  defective  operation,  as  the 
pyelitis  is  only  a  small  part  of  a  general  dis- 
ease. 

Th.  Gluck  has  lately  suggested  a  method  of 
pointing  out  which  kidney  is  diseased.  He 
advises  cutting  down  on  the  ureter  of  the  sup- 
posed morbid  kidney,  and  obliterating  its 
lumen  with  ligature  or  clamp.  A  solution 
of  some  salt,  rapidly  excreted  by  the  kidneys, 
is  then  injected  subcutaneously,  and  its  presence 


after  a  short  time  ascertained  in  the  urine  by 
means  of  tests ;  if  none  is  found,  then  the 
other  kidney  is  diseased,  and  the  ligature 
should  be  removed  and  the  wound  sewed  up  ; 
but  if  found  readily,  the  operation  of  excision 
is  proceeded  with. 

These  are  some  of  the  difficulties  in  the  way 
which  make  one  hesitate  to  perform  nephrec- 
tomy. Having,  however,  decided  on  the  oper- 
ation, which  is  the  best  incision,  through  the 
loin  or  abdomen  1  Certainly  the  abdominal 
incision  gives  the  operator  more  room,  and  the 
surgeon  sees  what  he  is  doing.  Kemoval 
through  an  incision  in  the  loin  is  very  difficult, 
especially  the  ligaturing  of  the  vessels  entering 
the  pelvis  of  the  kidney,  besides,  in  some 
people,  the  distance  between  the  last  rib  and 
crest  of  the  ilium  is  very  short ;  in  these  cases, 
of  course,  the  12  th  rib  has  to  be  excised,  or  a 
T  incision  made,  both  of  which  procedures 
increase  the  risk  of  the  operation.  The  only 
objection  to  the  abdominal  incision  is  that  two 
layers  of  peritoneum  are  wounded  ;  but  now-a- 
days  we  are  not  so  fearful  of  wounding  that 
structure  as  formerly.  I  leave  the  further 
discussion  to  you  as  to  when  and  how  we  should 
perform  nephrectomy. 

Treatment  of  Club-foot. — As  long  as  these 
deformities  occur,  so  long  will  the  remedying 
of  them  engage  the  attention  of  the  surgeon. 
Ordinary  simple  cases  may  be  successfully 
treated  by  bandaging  and  manipulating,  or  the 
use  of  elastic  springs.  More  severe  cases  by 
tenotomy,  and  afterwards  with  the  proper  ap- 
paratus, plaster-of-Paris,  splints,  &c.  I  should 
like  to  hear  from  the  members  of  this  Associa- 
tion their  opinion  as  to  the  performaince  of 
tenotomy,  whether,  for  instance,  in  a  case  of 
talipes  equino- varus  (the  most  common  form  of 
club-foot),  the  tibial  muscles  and  tendo  Achillis 
should  be  cut  at  the  same  time,  or  whether  two 
operations  should  be  made  of  the  tenotomy.  I 
feel  inclined  to  favour  the  latter  method,  fol- 
lowing in  the  lines  of  the  older  authorities, — 
first,  to  remove  talipes  yarns  by  tenotomy,  and 
after  application  of  a  splint,  and  later  on,  say 
in  two  orthree  weeks,  to  cut  the  tendo- Achillis, 
and  place  the  foot  in  good  position  in  a  plaster 
boot  or  Scarpa's  shoe.  It  seems  to  me  that  if 
the  operation  be  thus  performed  in  stages,  the 


OF  MEDICAL  SCIENCE. 


321 


necessity  for  the  more  severe  operations  may 
often  be  avoided.  I  should  also  like  to  hear 
the  opinion  of  the  members  as  to  the  tendency 
to  relapse.  In  my  limited  experience  this  ten- 
dency is  great,  if  the  after  treatment  by  man- 
ipulation and  splint  is  not  for  a  long  period 
continued. 

Mr.  Davy,  of  London,  advocates  in  severe 
cases  with  tendency  to  relapse  after  tenotomy, 
that  a  wedge-shaped  block  ^f  the  tarsal  arch 
should  be  removed  by  a  fine  saw  or  chisel ;  the 
base  of  the  wedge  is  outwards,  inwards,  or  up- 
wards, according  to  where  there  is  the  greatest 
deformity. 

Dr.  Phelps,  of  Chateauguay,  N.Y.,  has  lately 
introduced  a  new  operation  for  club-foot.  He 
makes  an  incision  across  the  sole  of  the  foot, 
and  divides  all  the  resisting  structures  down  to 
the  bones.  The  foot  is  then  brought  into 
position  on  a  special  splint,  and  the  wound  left 
open.  By  brushing  a  stick  of  nitrate  of  silver 
through  the  bottom  of  the  wound  the  granula- 
tions are  prevented  from  springing  up  too 
rapidly,  and  the  wound  is  induced  to  heal  from 
the  sides,  and  so  contraction  is  avoided.  I  am 
afraid  that  I  have  already  almost  exhausted 
your  patience,  and  so  shall  conclude  this  report 
by  touching  lightly  on  the  Surgery  of  the 
Joints.  Now-a-days,  joints  are  opened  fear- 
lessly, and  often  recklessly  and  unnecessarily. 
This,  no  doubt,  is  due  to  the  success  of  anti- 
septicism.  At  the  International  Congress  this 
subject  was  very  fully  discussed,  and  the 
feeling  among  English  surgeons,  at  any  rate, 
was  that  most  cases  of  joint  disease  could  be 
cured  by  rest.  They  deprecated  the  early  ex- 
cision which  was  advised  by  continental  sur- 
geons, and  thought  excision  should  only  be 
resorted  to  in  extreme  cases,  and  that  in  pri- 
vate practice  it  was  rarely  necessary.  Since 
the  Congress,  a  method  of  treating  diseased 
joints  by  Erasion  has  come  into  vogue.  Where 
the  disease  is  confined  to  the  synovial  mem- 
brane, an  incision  is  made  in  the  side  of  the 
joint,  an  instrument  introduced,  and  the  dis- 
eased parts  of  the  synovial  membrane  scraped 
away.  The  wound  is  then  stitched  up  and  a 
drainage  tube  inserted.  Cases  are  reported 
where,  after  healing  of  the  wound,  passive 
movement  was  commenced,  and  the  patients  re- 


covered, with  easily-movable  and  almost  perfect 
joints.  Where  the  disease  commences  in  the 
bone,  trephining  and  scraping  out  the  diseased 
bone  has  been  successfully  accomplished,  the 
patients  recovering  with  perfect  joints. 

Konig,  of  Gottingen,  in  a  paper  on  the  tu- 
berculosis of  bone  and  joints,  says  the  synovial 
membrane  is  rarely  the  primary  seat  of  diseaae 
in  tuberculosis  cases,  and  that  not  even  in  the 
most  favourable  cases  can  any  cure  be  exj^ected 
from  any  therapeutical  measure  short  of  a  sur- 
gical operation.  The  surgeon  should  aim  at 
removing  the  primary  morbid  deposit  in  the 
bone,  and  then  extirpate  the  diseased  parts  of 
the  synovial  membrane.  In  his  after  treatment 
he  finds  Iodoform  of  the  greatest  service.  In 
cases  where  it  is  used  the  discharge  is  usually 
scanty,  and  the  first  antiseptic  dressing  may 
remain  on  for  many  days.  He  lays  great 
stress  on  the  p»int  that  the  disease  in  the  arti- 
cular ends  of  bones  should  be  removed  before 
the  joint  is  afiected,  and  where  it  has  ah-eady 
reached  the  joint,  if  the  joint  is  opened  early, 
the  disease  may  be  removed  before  the  synovial 
membrane  is  afiected. 

I  know  that  our  worthy  President  is  rather 
sceptical  about  these  cases,  and  so  great  has 
been  his  success  with  excision,  of  the  knee 
especially,  that  he  prefers  to  adhere  to  the 
practice  for  which  he  is  so  well  known.  I 
merely  present  these  methods  of  treatment  to 
you  for  discussion,  trusting  that  some  new 
light  may  be  thrown  on  the  subject. 

And  now,  Mr.  President  and  gentlemen,  I 
have  come  to  the  end  of  the  subjects  I  pro- 
posed in  the  beginning  of  the  report  to  touch 
upon.  I  feel  that  I  have  but  poorly  accom- 
plished the  task  I  set  myself  to  do;  still,  I 
shall  feel  amply  satisfied  if  you,  with  your 
matured  wisdom  and  experience,  will  add  your 
quota  to   the   knowledge  we   already  have  of 

these  subjects. 

►  >  •  I « 

Dr.  Frisch,  in  Wien.  Med.  Woch.,  on  the 
cause  of  "chronic  thickening  of  the  mucous 
membrane  of  the  nose,"  states  that  in  twelve 
examples  which  he  examined,  stafi'-like  bacteria 
were  found.  These  organisms  penetrated  the 
cells  of  the  lining  membrane,  and  in  this  way 
excited  persistent  inflammation. 


322 


CANADIAN  JOURNAI. 


REPORT  OF  THE   COMMITTEE   ON 
MEDICINE  FOR  1881-82. 

(Read  before  the  Canada  Medical  Assoc,  Juno  8,  1882.) 

Two  events  have  occurred  during  the  past 
year  which  will  cause  it  to  be  long  remembered 
by  the  medical  world.  The  first  is  the  meet- 
ing of  the  International  Congress  in  London 
last  summer,  and  the  second — and  in  many 
respects  the  more  important — the  recent  pub- 
lication of  the  discoveries  in  tuberculosis  made 
by  Koch,  of  Berlin.  With  regard  to  the  Medi- 
cal Congress,  little  will  be  said  more  than  that 
in  every  respect  it  was  a  grand  success,  worthy 
of  the  city  in  which  it  was  held,  and  of  the 
men  who  most  actively  promoted  the  scheme. 
The  reports  of  the  Medical  Department  alone 
are  altogether  too  voluminous  to  be  epitomized, 
and  your  Committee  can  only  refer  the  mem- 
bers of  this  Association  to  the  volumes  already 
published,  being  assured  that  they  will  well 
repay  perusal. 

In  this  paper,  however,  the  reader  will 
confine  himself  to  the  second  great  event  of  the 
year,  viz.,  Koch's  discoveries  in  tuberculosis, 
preferring  to  trace  the  progress  of  our  know- 
ledge with  regard  to  one  disease,  rather  than  to 
go  over  the  whole  field  of  medicine.  In  our 
opinion  the  latter  is  given  so  fully  in  the  annual 
reports  of  the  Medical  Journal  as  to  render 
the  reiteration  unnecessary. 

Tuberculosis  is  a  disease  which  for  many 
reasons  is  well  worthy  of  our  attention.  It  is 
by  far  the  most  fatal  of  all,  not  excluding 
cholera  or  plague.  From  statistics  it  has  been 
shown  that  one-seventh  of  the  world's  mortality 
is  due  to  it.  Any  new  light,  then,  which  may 
be  thrown  on  its  causation,  or  any  new  points 
as  to  treatment,  are  hailed  with  satisfaction  by 
the  practising  physician. 

In  order  to  obtain  a  more  correct  idea  of  the 
present  state  of  our  knowledge,  it  is  necessary 
to  make  a  study  of  the  literature  of  the  disease 
from  the  beginning.  To  do  this,  one  might 
begin  with  Lsennec,  whose  treatise  is  a  very 
remarkable  one,  considering  the  slim  advan- 
tages he  possessed  compared  with  the  patholo- 
gists of  the  present  day.  Many  of  his  ideas, 
which  for  years  had  been  departed  from,  have 
again  been  accepted,  an  ample  proof  of  their 
correctness. 


He  included  under  the  head  of  tubercle  both 
the  grey  miliary  bodies  and  the  yellow  cheesy 
matter,  the  result  of  inflammatory  exudation, 
thus  giving  two  forms  of  tubercle,  the  grey 
and  the  yellow. 

Virchow,  who  commenced  his  investigations 
of  the  disease  in  1850,  limited  the  true  tubercle 
to  the  grey  miliary  bodies,  considering  the 
yellow  masses  to  be  simply  the  result  of  a 
peculiar  transformation  of  an  inflammatory 
exudation.  According  to  his  teaching,  in  the 
earliest  stages  the  tubei-cle  is  a  small  body, 
about  the  size  of  a  pin's  head,  composed  of 
lymphoid  cells  in  a  very  fine  stroma.  This 
body  unites  with  others  to  form  nodules  the 
size  of  millet  seeds.  These  latter  shortly  un- 
dergo a  peculiar  form  of  degeneration  which  he 
styled  caseation.  This  process  is  marked  first 
by  a  drying,  and  afterwards  a  fatty,  change. 
This  is  speedily  followed  by  necrosis  and  soft- 
ening. Other  mobid  conditions  exhibit  the 
form  of  degeneration  as  simple  inflammation, 
carcinoma,  &c.  In  none,  however,  does  it  occur 
so  constantly  or  come  on  so  early  as  in  tuber- 
culosis. 

Our  present  ideas  of  tubercle  do  not  mate- 
rially difier  from  those  of  Virchow,  except 
that  in  tlie  centre  of  tubercles  large  epithe- 
lioid cells  have  been  discovered,  which  are 
called  giant  cells.  Our  knowledge,  then,  of 
the  pathological  histology  of  this  condition 
may  be  summed  up  as  follows  : — Tubercles  are 
small  nodules,  the  result  of  an  inflammatory 
process,  which  are  made  up  of  giant  cells  sur- 
rounded by  lymphoid  cells  contained  in  a  very 
fine  stroma.  These  bodies  present  the  peculiar 
characteristic  of  early  caseation.  When  we 
combine  the  two  characteristics,  first,  that  of 
possessing  giant  cells,  and,  second,  early  casea- 
tion, we  have  a  form  of  disease  which  differs 
from  any  other,  although  either  characteristic 
may  be  shown  to  a  greater  or  less  extent  in 
other  morbid  conditions. 

We  will  now  pass  on  from  the  minute  mor- 
bid anatomy  to  the  etiology  of  tuberculosis. 

Several  years  ago  Villeniin  established  by 
experiment  the  fact  that  lower  animals  when 
infected  by  tuberculous  matter  would  them- 
selves suffer  and  die  from  tuberculosis. 

I  need  not  give  the  experiments  in  detail,  as 


OF  MEDICAL  SCIENCE. 


323 


they  are  no  doubt  familiar  to  most  of  you.  It 
was  demonstrated  (1)  that  infection  could  thus 
be  carried  ;  (2)  that  the  disease  always  followed 
the  natural  channels,  affecting  first  parts  near 
the  point  operated  on;  (3)  that  tubercular  mat- 
ter produced  the  same  result,  no  matter  from 
what  organ  or  part  of  the  body  it  was  taken, 
whether  from  the  lung,  liver,  testicle,  <kc. ;  (4) 
all  animals  were  not  equally  susceptible — 
Guinea  pigs  and  rabbits  were  easily  affected, 
dogs,  ou  the  other  hand,  with  difficulty ;  (5) 
the  infection  was  successfully  carried  in  several 
different  ways — by  inoculation,  by  the  breath, 
and  by  feeding. 

Prof  Cohnheim,  in  an  address  published  in 
1880  on  tuberculosis,  from  the  standpoint  of 
the  contagion  theory,  proceeds  to  explain  the 
many  forms  of  the  disease  found  in  the  human 
subject  according  to  this  doctrine.  In  adults, 
the  lungs  are  the  organs  by  far  the  most  fre- 
quently affected  primarily.  The  virus  in 
minute  particles  is  easily  breathed  in.  In 
children,  the  bowels  are  most  frequently  affec- 
ted, a  fact  which  is  probably  owing  to  the  pre- 
sence of  the  virus  in  the  food,  perhaps  in  the 
milk  of  afiected  cattle. 

The  spread  of  the  disease  from  one  organ  to 
another  is  also  an  evidence  of  the  presence  of 
virus.  For  instance,  the  lungs  are  first  affec- 
ted, then  the  bronchial  glands,  then  the  larynx 
is  attacked  from  the  infected  matter  passing 
over  it.  The  pharynx  follows  in  order.  The 
oesophagus  escapes  as  the  matter  passes  through 
with  rapidity  into  the  stomach.  The  latter 
organ  escapes,  owing  to  the  antiseptic  character 
of  the  gastric  juice.  When,  however,  a  cat- 
arrh of  the  stomach  takes  place  from  the  pre- 
sence of  so  much  irritating  matter,  the  gastric 
juice  loses  its  properties,  and  the  virus  passes 
through  into  the  intestine,  affecting  first  the 
mucous  membrane  and  afterwards  the  neigh- 
bouring lymphatic  glands  and  the  peritoneum. 
There  is  no  doubt  but  that  the  virus  can  also 
be  carried  by  the  blood  to  distant  organis,  the 
brain,  for  instance. 

There  are  many  points  in  connection  with 
the  hereditary  character  of  tuberculosis,  and  of 
the  manner  in  which  the  disease  may  remain 
dormant  in  the  system,  which  might  at  first 
present   serious  difficulties  to  the  doctrine  of 


contagion.  When,  however,  one  compares  the 
disease  with  syphilis,  which  is  accepted  on  all 
hands  to  be  contagious,  many  of  these  difficul- 
ties disappear.  In  the  same  way  as  the  virus 
of  syphilis  is  carried  over  from  one  generation 
to  the  next,  may  not  the  virus  of  tuberculosis 
be  so  carried,  through  the  semen  or  ovum  ^  As 
syphilis  may  be  apparently  cured,  and  suddenly 
break  out  again  after  yeara  of  freedom  from  it, 
does  not  tuberculosis  also  remain  dormant,  and 
from  some  sudden  irritation  again  commence 
its  ravages  1 

The  very  sudden  outbreak  of  tuberculosis  by 
which  patients  are  sometimes  carried  off  in  a 
few  days  or  weeks,  is  in  all  probability  pro- 
duced by  the  virus  passing  into  the  general 
circulation,  from  some  caseous  gland  in  which 
it  may  have  existed  for  years.  The  writer  has 
himself  recently  seen  a  case  of  tuberculosis  in 
which  the  patient  was  carried  off  aft^r  nine 
days'  illness,  and  in  which  almost  every  organ 
of  the  body  was  found  to  be  affected  with  tub- 
ercle. An  old  caseous  gland  was  discovered 
near  the  root  of  the  lung,  which  had  no  doubt 
been  for  months  or  years  in  existence. 

When  it  is  considered  that  Prof.  Cohnheim 
collected  and  gave  to  the  profession  all  these 
facts  and  inferences  in  an  address  made  over 
two  years  ago,  an  address  in  which  he  prophe- 
fcied  the  certain  discovery  of  the  virus,  one  is 
not  surprised  that  the  whole  medical  world 
should  be  moved  with  the  deepest  interest 
when  Koch,  of  Berlin,  demonstrated  the  pre- 
sence of  the  bacteria,  which,  according  to  his 
ideas,  are  the  cause  of  the  disease.  He,  after 
two  years  of  the  most  painstaking  work,  suc- 
ceeded by  a  certain  process  of  staining  in  bring- 
ing into  view  certain  bacteria,  which  he  could 
only  find  in  tubercular  tissue  or  sputa,  and 
which  he  could  readily  distinguish  from  all 
other  forms  of  bacteria.  These  bacilli,  which 
will  be  demonstrated  to  you,  are  small  rod-like 
bodies,  about  a  third  the  length  of  the  diame- 
ter of  a  blood  corpuscle,  and  have  a  curved 
shape.  They  appear  to  be  made  up  of 
spores. 

Koch,  in  his  investigation  of  tuberculosis,  in 
both  men  and  animals,  scarcely  ever  failed  to 
find  the  bacilli.  He  found  them  both  in  cases 
where  the  disease  was  produced  by  infection, 


324 


CANADIAN  JOURNAL 

1 


and  also  where  the  disease  was,  so  to  speak,  of 
spontaneous  origin. 

He  made  also  experiments  in  which  he  ino- 
culated animals  with  bacilli  which  he  had 
cultivated  in  serum.  The  disease  was  pi'oduced 
in  the  same  way  as  in  his  previous  cases.  It 
is  not  necessary  to  go  further  into  the  details 
of  this  paper,  as  you  no  doubt  have  all  read  it. 
One  cannot  read  it  without  being  convinced 
that  if  he  has  made  no  mistake  in  his  manip- 
ulation, he  has  discovered  the  I'eal  cause  of 
the  disease.  That  he  has  made  such  a  mistake 
is  not  likely,  as  he  is  a  most  careful  and  pains- 
taking enquirer.  He  has  spent  eight  yeai's  in 
the  investigation  of  bacteria,  the  last  two  of 
which  were  entirely  devoted  to  the  pathology 
of  tuberculosis. 

Since  the  appearance  of  his  paper  in  the 
Berliner  Klinische  Wochenschrift,  the  attention 
of  pathologists  throughout  Germany  has  been 
directed  to  this  subject.  Baumgarten,  of 
Koenigsberg,  claims  to  have  made  the  discovery 
before  the  publication  of  Koch's  paper.  He 
made  a  number  of  experiments  which  forced 
him  to  the  conclusion  that  the  disease  was  in- 
fectious, and  that  the  real  cause  could  be  dis- 
covered. Not  the  least  interesting  are  the 
experiments  in  which  he  infected  animals  with 
a  number  of  fluids,  as  ordinary  pus,  fluid  of 
sarcomata,  and  carcinomata,  decomposed  pus,  old 
dried  blood,  &c.,  without  in  any  case  producing 
tuberculosis.  Ehrlich  has  in  his  investigations 
instituted  a  method  of  staining  much  simpler 
than  that  of  Koch,  and  quite  as  efiective. 
Take  a  test  tube  half  filled  with  distilled  water, 
add  to  it  aniline  oil  until  there  is  a  slight 
cloudiness,  then  filter.  To  the  filtered  solution 
add  fuchsine,  an  aniline  colour,  until  there  is 
a  slight  cloudiness.  Care  must  be  taken  not  to 
add  too  much  fuchsine,  as  the  liquid  will  be- 
come clear  again.  In  this  way  the  colouring 
fluid  is  made.  Now  take  some  tubercular 
sputa,  place  a  small  drop  on  a  cover  glass,  press 
another  cover  glass  over  it,  so  as  to  leave  only 
a  thin  layer,  and  allow  them  to  dry.  When 
dry,  pass  them  through  a  Bunsen  flame,  and 
place  them  with  the  sputa  side  downwards  in 
the  colouring  fluid,  and  allow  them  to  remain 
in  a  half  an  hour  in  a  warm  temperature. 
If  the   solution  is  cold,    the  glasses  must  be 


allowed  to  remain  much  longer.  Now  take 
them  out  and  pass  them  through  a  solution  of 
nitric  acid  in  proportion  of  ten  to  twenty-six, 
wash  out  with  water,  dry,  and  mount  in  Canada 
balsam.  I  am  indebted  to  Dr.  Councilman,  of 
Baltimore,  for  the  minute  particulars  under 
whose  direction,  in  Prof.  Chiari's  laboratory, 
the  reader  of  this  report  has  several  times 
made  the  experiment.  The  rationale  of  the 
process  is  as  follows  : — (1).  The  heating  in 
Bunsen  flame  fixes  the  albumen  on  the  glass,  so 
that  it  is  not  removed  by  repeated  washings. 
(2).  After  the  staining,  it  is  passed  through  a 
nitric  acid  solution,  so  as  to  decolorize  the  sur- 
rounding elements.  The  bacilli  appear  to 
retain  the  staining  notwithstanding  the  strong 
acid.  In  this  way  one  can  almost  always  find 
bacilli  in  tubercular  sputa,  and  they  are  never 
found  in  that  of  any  other  disease.  As  a 
means  of  diagnosis  this  may  be  a  matter  of 
great  importance.  There  have  been  instances 
in  which  bacilli  were  found  in  the  sputa  of 
persons  supposed  to  be  suffering  from  typhoid 
fever,  but  when  the  post-mortem  was  made 
they  were  shown  to  have  died  of  miliary  tub- 
erculosis. In  our  opinion,  many  cases  have 
been  put  down  as  typhoid  which  have  really 
been  tubercular. 

After  describing  the  discovery  of  these 
germs,  and  the  manner  in  which  they  appear 
to  convey  the  disease,  Koch  goes  on  to  explain 
the  phenomena  of  tuberculosis  according  to  this 
theory.  That  the  disease  appears  so  frequently 
in  the  lungs  is  readily  explained,  as  the  germs 
are  easily  taken  in  in  respiration.  These  bac- 
teria appear  to  be  effective  in  producing  the 
disease  after  long  exposure.  Koch  succeeded 
in  producing  the  disease  by  the  inoculation  of 
sputa  four  weeks'  old.  Patients  are  not  easily 
affected  when  the  epithelium  is  intact,  but 
when  erosions  or  congestions  take  place,  the 
germs  find  a  ready  entrance  into  the  body.  In 
children  the  bowels  are  most  frequently  af- 
fected, on  account  of  the  contagious  matter 
introduced  with  the  food.  It  is  diflficult  to 
explain  the  hereditary  nature  of  the  disease  by 
means  of  this  theory.  It  is  quite  possible  that 
individuals  bom  with  a  week  constitution,  and 
possessing  a  tendency  to  low  inflammation,  and 
I  cheesy  degeneration,  should  be  very  susceptible 


OF  MEDICAL  SCIENCE. 


325 


to  the  virus  of  tuberculosis.  The  caseous 
matter  appears  to  be  an  excellent  nucleus  for 
the  development  of  bacteria.  It  is  diflficult  to 
say  whether  the  virus  in  some  different  form 
might  not  be  carried  over  from  one  generation 
to  another  through  the  ovum  or  semen,  in  the 
same  way  as  in  syphilis. 

From  the  experiments  made,  there  is  no 
doubt  that  bacteria  exist  in  tuberculosis.  So 
far  as  yet  known  they  do  not  exist  in  any 
other  form  of  disease.  That  they  are  the 
cause  of  the  disease  seems  probable.  No 
authority  has  yet  been  able  to  contradict 
Koch's  assertion.  In  fact,  the  results  of  the 
investigations  so  far  go  still  more  strongly  to 
confirm  it.  If  after  thorough  investigation  it 
should  be  finally  confirmed,  a  great  advance 
will  be  made  towards  the  prevention  of  this 
frequent  and  fatal  disease. 


ANTISEPTIC  TREATMENT  OP 
PHTHISIS. 

(Read  before  the  Ontario  Medical  Assoc,  June  8, 1882.) 

BY  D.  L.  PHILIP,  M.D.,  CM.,  BRANTFORD,  ONT. 

Phthisis  is  now  being  treated,  with  reported 
success,  by  the  continuous  inhalation  of  the 
vapour  of  carbolic  acid  or  other  antiseptic 
agents,  by  means  of  an  almost  constantly- 
worn  respirator. 

"  It  is  fair  to  infer,"  says  the  British  Medical 
Journal,  "  that  the  application  to  internal  sup- 
purating surfaces  of  an  agent  which  has  been 
used  in  similar  cases  externally  with  such 
benefit,  will  be  equally  efficacious  in  checking 
the  growth  and  development  of  morbific  germs, 
and  thus  allowing  tissues  to  be  reconstructed." 

Recent  researches  on  tubercular  disease,  and 
the  nature  of  tubercle,  have  excited  great  at- 
tention, and  the  teachings  of  some  of  the 
German  pathologists,  notably  Yirchow,  are 
subversive  of  what  we  have  been  taught  re- 
garding its  existence,  and  especially  with 
regard  to  the  relation  which  it  sustains  to  in- 
flammatory processes,  some  of  the  leading 
pathologists  maintaining  the  view  that  the 
inflammatory  process  is  primary  to  tubercle, 
and  utterly  denying  the  tubercular  nature  of 
many    of    the   processes   engaged   in   phthisis 


pulmonalis.  Without  attempting  to  give  the 
views  recently  enunciated  by  them  in  this  ex- 
tensive field  of  enquiiy,  I  would  like  to  draw 
the  attention  of  the  Association  to  a-  compara- 
tively new  method  of  treatment  with  which 
general  practitioners  are  more  immediately 
concerned,  and  which  has  been  used  during  the 
past  two  years,  with  a  considerable  degree  of 
success,  by  Dr.  McKenzie,  of  Edinburgh,  Dr. 
Williams,  of  London,  and  others.  They  were 
probably  led  to  adept  this  method  of  treatment 
from  the  views  recently  set  forth  as  to  the 
septic  and  eminently  contagious  character  of 
tubercle, — I  allude  to  the  inhalation  of  the 
vapour  of  carbolic  acid  or  other  antiseptic 
agents  for  lengthened  periods,  as  practised  by 
Dr.  McKenzie  with  apparently  highly  benefi- 
cial results.  The  inhalation  of  vapours  in  lung 
difceases  has  long  been  practised,  but  the  mode 
of  administration  has  been  so  defective  that 
the  practice  has  to  a  great  extent  fallen  into 
disuse.  It  has  also  been  adopted  by  advertis- 
ing charlatans  in  an  imperfect  way,  and  has 
thus  helped  to  bring  it  into  undeserved  disre- 
pute with  the  profession.  It  is  now,  however, 
as  a  rational  method  of  treatment  extensively 
employed  by  leading  and  eminent  medical  men 
with  no  doubt  the  happiest  results. 

Late  investigation  goes  to  show  that  phthisis 
pulmonalis  is  eminently  contagious,  and  may 
be  propagated  by  direct  infection  from  man  to 
man. 

Dr.  Reich  observed  "in  the  Village  of  Neien- 
burgh,  situated  on  a  high  bluff  of  the  Rhine, 
and  enjoying  excellent  hygienic  conditions, 
from  July  11th,  1876,  till  Sept.  29th,  1877, 
ten  deaths  from  tubercular  meningitis  in  child- 
ren born  between  April  4th,  1876,  and  May 
6th,  1877.  No  hereditary  disposition  could  be 
established.  All  these  children  were  attended 
by  the  same  midwife,  suffering  from  lung  dis- 
ease (caverns,  and  sanio  purulent  sputa).  She 
died  July  23rd,  1877.  She  had  the  bad  habit 
when  a  child  was  born  of  I'emoving  the  phlegm 
from  the  respiratory  passages  by  aspiration 
with  her  mouth,  and  in  slight  cases  of  asi)hyxia 
of  blowing  air  into  the  child's  mouth." 

Schuler,  of  Grriefswald,  has  proved  that  ani- 
mals in  which  artificial  tuberculosis  has  been 
induced  by   injection,  die  without   exception, 


326 


CANAD1A.N  JOURNAL 


with  the  usual  phthisical  symptoms,  viz.,  ema- 
ciation, loss  of  heat,  and  afterwards  general 
miliary  tuberculosin.  Amongst  others  who 
have  given  the  weight  of  their  authority  to 
the  belief  that  tuberculosis  is  contagious  are 
Mr.  Simon  and  Dr.  Greenfield,  such  contagion 
being  frequently  spread  by  the  milk  of  high- 
class  cows,  which  are  very  subject  to  the  dis- 
ease. It  is  important  to  note  that  whilst  the 
lower  animals  may  communicate  the  disease  to 
man,  man  may  in  return  infect  the  lower  ani- 
mals. In  proof  of  this,  is  the  case  recorded 
by  Dr.  Cullimore  (British  Medical  Journal, 
May  22,  1880),  where  a  strong  healthy  dog 
lapped  up  the  sputum  of  a  tuberculous  man, 
and  died  in  a  short  time  of  pulmonary  phthisis. 
In  connection  with  this  must  be  mentioned  the 
spread  of  infection  within  the  same  individual 
from  one  organ  to  another.  Virchow  main- 
tained that  tuberculosis  spreads  from  organ  to 
organ  as  if  by  infection.  The  tubercular  virus 
enters  the  organism  most  c  >mmoi)ly  through 
the  air  passages,  and  thus  in  the  first  instance 
is  capable  of  favoring  pulmonary  tuberculosis. 
From  here  it  spreads  on  to  the  bronchial 
glands,  and  further  enters  the  general  system, 
or  by  swallowing  of  tuberculous  sputa  produces 
secondary  tuberculosis  in  the  intestines,  mesen- 
teric glands,  &c.  Or  the  virus  enters  primarily 
through  the  digestive  organs  with  the  food, 
notably  the  intestine,  and  from  here  the  infec- 
tion spreads  on  to  the  mesenteric  glands,  peri- 
toneum, and,  further,  the  general  system. 

Dr.  Pollock,  Senior  Physician  to  the  Hospital 
for  Diseases  of  the  Chest,  Brompton,  in  writing 
upon  phthisis  in  relation  to  modern  j^athology, 
says  : — "  Tubercle  is,  then,  not  an  essential  ele- 
ment in  the  disease,  but  where  found,  is  a  sec- 
ondary superadded  result  arising  from  infection, 
or  the  resorption  of  inflammatory  results  in  the 
individuals  themselves.  Tubercle  is  a  short- 
lived product,  arising  from  inflammatory  resi- 
dua which  have  undergone  degeneration — 
caseation — and  been  conveyed  into  the  system, 
or  to  distant  parts  of  the  lungs  or  other  organs, 
by  the  blood-vessels  and  lymphatics,  or  even 
directly  by  the  air-tubes.  Tubercle  probably 
lives  but  some  weeks  or  months,  but  the 
changes  in  the  lung  formerly  ascribed  to  tu- 
bercle may  last  for  years."      Charcot,  in  his 


study  of  the  thermometery  of  the  disease,  says  : 
"  The  thermic  curves  are  not  those  of  inflam- 
matory action,  but  of  putrid  infection,  and  in 
the  pyrexial  form  of  phthisis  the  exacerbation 
(of  temperature)  is  due,  not  to  a  pneumonic 
process,  but  to  resorption  of  softened  material." 
With  these  considerations  in  view,  the  prac- 
tical part  of  the  question,  viz.,  treatment,  may 
be  considered,  and  if  we  regard  phthisis  as  a 
disease  of  a  septic  parasitic  origin,  and  readily 
infectious,  as  modern  pathological  research 
would  lead  us  to  believe,  then  the  antiseptic 
treatment  is  a  highly  rational  one.  And  indeed 
the  success  already  met  with  in  the  treatment 
of  certain  forms  of  phthisis  by  this  method,  by 
Dr.  McKenzie,  Dr.  Yeo,  Dr.  Coghill,  and 
others,  should  secure  for  it  respectful  consider- 
ation and  an  extensive  trial.  In  order  to  carry 
it  out  eflTectually,  Dr.  McKenzie  has  devised  a 
very  ingenious  little  instrument,  which  he  calls 
the  naso  oral  respi'^ator,  which  covers  both  the 
mouth  and  nose,  and  cku  be  worn  for  hours  at 
a  time  without  the  least  inconvenience.  The 
]:)erforated  lid  upon  the  lower  part  of  the  in- 
strument can  be  removed  at  pleasure,  and  a 
sponge  saturated  with  carbolic  acid,  creasote, 
or  other  volatile  antiseptic  agents,  placed 
within.  The  air  in  the  respiratory  process 
passes  through  the  sponge  saturated  with  the 
vapor.  It  is  provided  with  inspiratory  and 
expiratoi'y  valves,  and  is  not  liable  to  get  out 
of  order. 

The  following  are  the  brief  notes  of  a  case 
which  I  have  recently  treated  by  this  method  : 
Miss  S.,  age  24,  of  good  family  history,  con- 
sulted me  about  six  months  ago,  complaining 
of  general  debility,  cough  which  had  been 
troubling  her  for  some  time,  slight  progressive 
emaciation,  loss  of  appetite,  shortness  of  breath 
upon  exertion,  «kc.  I  did  not  make  any  phy- 
sical examination  of  the  chest  at  the  time,  but 
prescribed  for  her  cod-liver  oil  with  hypophos- 
phites,  which  she  continued  to  use  for  some 
weeks  with  benefit.  I  did  not  see  her  again 
until  the  2nd  Sept.  last,  when  I  was  sent  for, 
as  she  had  on  that  morning  an  alarming 
hoemoptysis.  She  must  have  got  up  fully  a 
pint  of  blood.  I  at  once  ordered  her  to  bed, 
enjoined  perfect  quietude,  and  gave  her  fluid 
extract  ergot  and  iced  drinks.     Upon  visiting 


OF  MEDICAL  SCIENCE. 


327 


her  the  same  evening  1  found  that  the  sputum 
had  been  occasionally  tinged  with  blood.  Pulse 
112,  temperature  102.  Upon  examination  of 
the  chest  I  found  a  diffused  crepitant  rdle  over 
the  left  apex,  which  led  me  to  infer  that  the 
haemorrhage  had  come  from  this  portion  of  the 
lung.  The  history  of  the  case  for  the  next 
fortnight  was  unfavorable — afternoon  exacer- 
bations off  ever,  cough  troublesome,  sputa  now 
and  then  tinged  with  blood.  I  now  caused  her 
to  inhale,  as  continuously  as  possible,  the  vapor 
of  carbolic  acid  and  creosote,  equal  parts,  by 
means  of  the  respirator,  which  I  had  some  time 
since  procured  from  Edinburgh,  and  after  the 
manner  prescribed  by  Dr.  McKenzie.  On  an 
average,  she  continued  to  use  it  from  eight  to 
ten  hours  a  day  for  the  next  two  months,  with, 
I  think,  markedly  beneficial  results.  Her  im- 
provement appeared  to  go  on  from  the  period 
when  she  began  using  it,  and  at  the  present 
time,  though  not  strong  nor  robust,  she  is  in  a 
better  condition  of  health  than  she  was  for- 
merly— appetite  good,  very  little  cough,  and 
the  only  abnormality  I  can  detect  upon  auscul- 
lation  is  a  slightly  prolonged  expiration  over 
the  left  apex.  She  can  take  a  good  long  walk 
without  fatigue,  and  says  she  feels  better  than 
she  has  done  for  months  back.  She  still  con- 
tinues to  use  it  for  a  couple  of  hours  morning 
and  evening  each  day.  The  antiseptic  treat- 
ment is,  of  course,  to  be  employed  with  appro- 
priate constitutional  remedies.  In  this  case, 
however,  I  used  none,  partly  because  she  had 
"previously  taken  a  considerable  quantity  of 
cod-liver  oil,  and  had  a  very  decided  aversion 
to  its  use  in  any  form,  and  I  also  wished  to 
observe  the  effect  of  the  antiseptic  per  se. 

Whether  the  beneficial  effect  resulting  from 
the  inhalation  of  these  antiseptic  vapours  is  due 
to  its  destructive  action  upon  the  germs  to 
which  the  formation  of  pus  is  attributed,  or  to 
its  action  as  a  preventative  of  septic  poisoning 
from  the  local  centres  in  the  lungs,  it  is  evident 
that  their  use  has  a  decidedly  curative  action 
in  diminishing  expectoration,  and  with  it  the 
cough  in  the  various  forms  of  phthisis,  during 
the  resolution  of  pneumonia,  and  in  the  puru- 
lent stages  of  bronchitis. 

Should  the  employment  of  the  antiseptic  be 
local  or  constitutional]      Dr.  McKenzie  says  : 


"  My  therapeutical  experience  leads  me  to 
believe  that,  as  shown  by  Matthews  Duncan  to 
be  the  case  in  some  examples  of  puerperal  fever, 
it  is  more  frequently  a  condition  of  sapremia 
than  jryemia,  which  obtains  in  phthisis ;  that 
the  toxemia  is  rather  attributable  to  the  chem- 
ical factors  which  putrefaction  engenders  than 
to  the  presence  of  micrococci  in  the  tissues  and 
blood.  I,  therefore,  think  that  it  is  only  by 
the  local  application  of  the  antiseptic  that  good 
results  can  be  obtained. 


TUBERCULOSIS. 

W.    H.    AIKINS,  M.D.,  L.R.C.P.,  LOND.,  VIENNA. 

(The  following  cases  have  been  reported  by 
Dr.  W.  H.  Aikins  from  Prof.  Chiari's  Labora- 
tory, Vienna.  The  first  is  not  an  unusual  in- 
stance of  confirmation  of  the  clinical  diagnosis 
by  the  absence  of  bacilli.  In  the  second,  the 
presence  of  bacilli  was  demonstrated  in  a  tuber- 
cular nodule  far  from  the  respiratory  system, 
and  in  a  situation  where  tubercle  is  rarely 
found.— J.  E.  G.) 

John  P.,  aged  29,  piano-maker. 

Clinical  diagnosis  :  Pleuritis.  Body  medium 
size,  slightly  built.  Emaciated,  pale.  Im- 
mediately on  the  left  side  of  the  sternum,  cor- 
responding to  cartilage  of  3rd  rib,  was  an 
abscess  the  size  of  a  hazel-mit.  In  the  trachea 
a  slight  quantity  of  mucus  ;  the  mucous  mem- 
brane of  both  larynx  and  pharynx  pale.  The  left 
lung  in  its  whole  extent  adhered  to  the  pleura ; 
both  its  parietal  and  visceral  layers  thickened 
into  cartilage-like  bands.  The  left  lung  in  its 
whole  extent  shrunken  ;  volume  one-third  that 
of  a  normal  lung.  Lung  traversed  by  dense 
bands  of  fibrous  tissue.  In  the  shrunken  and 
compressed  parenchyma  of  the  lung  no  air  was 
present,  in  the  apices  several  cavities  due  to 
bronchiectasis  the  size  of  hazel  nuts.  In  other 
parts  of  the  lung  were  several  partially  calcified 
partly  caseous  nodules.  The  right  lung  vicari- 
ously enlarged,  cedematous,  and  containing 
numerous  old  caseous  partly  calcified  nodules, 
none  larger  than  a  pea.  In  the  pericardium 
about  200  c.  c.  cloudy  serum,  both  the  visceral 
and  parietal  surfaces  covered  with  a  fibrous 
exudation  ;  heart,   ordinary  size,  valves  sott  j 


328 


CANADIAN  JOURNAL 


liver,  slightly  fatty ;  spleen,  normal  size  ;  kid- 
neys, granular  ;  bronchial  glands,  enlarged  and 
slightly  caseous ;  supra-renal  capsules  showed 
no  changes. 

N.  B. — The  sputa  of  this  man  were  examined 
three  days  before  his  death  with  a  view  to 
ascertaining  whether  or  not  tubercular  bacilli 
were  present — none  were  found. 

TUBERCLE  OF  THE  OVARY,  IN  WHICH  BACILLI 
WERE  FOUND. 

Marie  D.,  aged  39,  housemaid. 

Clinical  Diagnosis :  Tuberculosis  pulmon. 
Body  small,  weakly  built,  and  poorly  nourished  ; 
brain  and  meninges  pale  ;  a  quantity  of  muco- 
purulent matter  in  the  trachea.  The  right  lung 
compressed  to  half  its  normal  size  owing  to  a 
pneumothorax.  From  a  large  cavity  in  the 
lung  there  was  a  perforation  leading  into  the 
pleural  sac.  In  the  apices  of  lungs  were  num- 
erous cheesy  masses,  and  several  large  cavities. 
Bronchial  glands,  increased  in  size  and  filled 
with  turbercles.  Spleen,  enlarged,  contained 
many  caseous  nodules.  In  substance  of  liver 
and  kidneys  were  also  numerous  small  nodules  ; 
surface  of  diaphragm  covered  with  miliary 
tubercles.  In  the  left  ovary  was  a  sharp,  well- 
defined,  yellowish  coloured  mass,  about  the 
size  of  a  pea,  surrounded  by  a  zone  of  hyper, 
semic  tissue.  Not  being  certain,  at  the  time 
the  post-mortem  was  made,  what  the  character 
of  the  nodule  in  the  ovary  was,  it  was  examined- 
under  the  microscope,  and  appeared  to  be  dis 
tinctly  tubercular.  Caseation  had  commenced 
in  the  centre  of  the  mass ;  no  giant  cells  were 
to  be  seen.  I  then  examined  it  for  tubercular 
bacilli,  and  found  fehem  present  in  large  num- 
bers at  the  edge  of  the  tubercle,  where  the 
active  progi'ess  was  taking  place. 


ON  THE  CONTAGION   OF  APHTHOUS 
FEVER  IN  THE  HUMAN  SPECIES. 

BY    P.    H.  BRYCE,  M.A.,  M.D..  SECRETARY    PROVIN- 
CIAL   BOARD    OF    HEALTH. 

{From  the  Journal  d^ Hygiene) 

The  Nice  Medical  having  lately  published 
an  interesting  article  on  the  transmission  of 
aphthous  fever  from  animals  to  man,  Prof. 
Lussana  of  Padona,  gives  us  pleasure  through 


the  communication  of  facts  which  he  has  ob- 
served since  1851  among  the  plateaus  which 
surmount  the  high  mountains  of  Gaudino 
(Lombardy). 

An  epidemic  of  aphthous  fever  had  broken 
out  among  the  numerous  herds  (more  than  a 
thousand  animals)  scattered  over  these  magni- 
ficent pastu»ages.  The  epizootic  had  infected 
about  seven-eighths  of  the  bovine  and  two-fifths 
of  the  porcine  species. 

On  all  were  found  characteristic  aphthous 
eruptions  at  the  bifurcation  of  the  hoofs,  in 
the  mouth,  on  the  snout,  at  the  opening  of 
the  nasal  fossae,  and  on  the  teats ;  never  any- 
where else.  It  was  evident  that  the  virus 
secreted  by  the  interungueal  vesicles  had 
polluted  the  herbs  of  the  field  trodden  upon 
by  the  feet  of  the  animals,  and  that  these 
herbs  had  thus  borne  the  contagion  to  the 
buccal  mucous  membrane  and  the  udders. 
Nevertheless,  the  progress  of  the  epizootic  was 
very  mild,  and  the  sickness  resulting  from  it 
very  slight. 

The  diminution  of  the  production  of  milk 
from  milch  cows  became  apparent  only  in  the 
course  of  the  second  week  of  the  disease,  and 
all  the  milk,  as  well  as  all  the  butter,  was 
used  without  afiecting  the  amount  consumed 
throughout  the  country. 

As  to  the  fact  of  the  transmissibility  of  the 
disease,  these  are  his  observations : 

One  of  the  herdsmen  presented  a  character- 
istic aphthous  cicatrix,  on  the  gum  at  the 
base  of  the  roots  of  the  two  upper  incisors. 
Also  a  characteristic  alteration  on  the  internal 
mucous  membrane  and  middle  of  the  lower 
lip.  Recovery  took  place  at  the  end  of  two 
weeks,  without  marked  injury  to  the  general 
health. 

M.  Lussana  had  inoculated  himself  by 
means  of  a  vaccine  needle,  on  the  left  fore-arm, 
with  u  portion  of  the  ichorous  humour  obtained 
from  the  udder  of  a  sick  cow  ;  there  followed 
no  eruption  and  no  malaise.  The  virus  of  the 
aphthous  epizootic  is  not  transmissible  by  skin, 
(except  the  interungueal  tissue  in  cloven-footed 
animals),  but  it  is  transmissible  by  the  mucous 
membranes  of  these  animals,  as  well  as  those 
of  man. 

The  cows  have  always  been  milked  b    i      a 
without  the  persons  doing  this  jjrese 
least  eruption.  nting  thg 


OF  MEDICAL  SCIENCE. 


329 


Mtciim$:  W^tAxmt, 


SUB-CLAVICULAR  TYMPANISM. 

M.  J.  Grancher  concludes  a  very  interesting 
communication  to  the  Medical  Society  of  the 
Hospitals  upon  Sub-clavicular  Tympanism  as 
follows  : — 

Being  given  an  acute  or  subacute  pleurisy 
in  a  healthy  man,  accompanied  with  a  n^sdium 
effusion  we  may  find  out  by  the  physical  signs 
the  part  taken  by  the  Inng  in  the  pathological 
process. 

All  clinical  methods  heretofore  employed 
seek  to  determine  the  condition  of  the  lung 
behind  the  effusion,  that  is  to  say  at  the  base  ; 
none  allows  us  to  determine,  what  is  most 
important  as  regards  the  distant  prognosis  of 
the  pleurisy,  the  condition  of  the  apex  above 
the   effusion. 

The  healthy  or  pathological  condition  of 
the  upper  lobe,  may  be  deduced,  not  from  such 
or  such  a  sign  considered  alone,  but  from  the 
relation  of  the  three  principal  physical  signs, 
viz  ,  resonance,  vocal  vibrations,  and  respira- 
tion. 

Three  capital  circumstances  may  be  met  with, 
and  each  of  them  corresponds  to  a  particular 
condition  of  the  apex : 

1st.  The  sub-clavicular  tympanism  coincides 
with  an  increase  of  the  vocal  vibrations  and 
increased  respiration. 

This  association  of  physical  signs  indicates 
that  the  supei'ior  lobe  is  healthy,  that  it  is 
resonant,  that  it  vibrates,  and  that  it  respires 
in  a  supi)lemental  manner. 

This  is  a  particular  case  of  a  general  law 
called  the  law  of  compensation  and  the  schema 
which  corresponds  to  it  may  be  designated  under 
the  name  of  schevia  or  typanism  of  compen. 
sation. 

2nd.  The  sub-clavicular  tympanism  again  is 
accompanied  with  an  increase  of  the  vocal 
vibrations,  but  there  exists  at  the  same  time  an 
abnormal  respiration. 

This  second  variety  of  tympanism  is  the 
most  common  of  all. 

All  the  abnormal  respirations  described  by 
authors  may  be  observed,  but  by  far  the  most 
frequent  is  weak  respiration. 


This  combination  of  physical  signs  may  be 
called   schema  or  tympanism  of  congestion. 

This  congestive  condition  is  most  often,  though 
not  constantly  of  tubercular  origin.  Its  true 
nature  may  be  deduced  from  later  observation 
of  the  patient,  from  the  study  of  his  antece- 
dents and  the  functional  symptoms  that  he 
presents. 

3rd.  The  sub-clavicular  tympanism  may  be 
encountered  with  a  diminution  of  the  respira- 
tory murmur  and  a  diminution  of  the  vibra- 
tions. 

This  third  combination,  rarer  than  the  pre- 
ceding, answers  probably  to  divers  pathological 
conditions.  I  have  found  it  realised  up  to  the 
present  with  compression  of  the  bronchi  and 
by  oedema  of  the  lungs.  That  is  why  I  call  it 
provisionally  schema,  or  tympanism  of  bronchial 
compression  and  pulmonary  cedema. — L' Union 
Medical. 


Localized  (Edema. — M.  Guyot,  at  the  Med- 
ical Society  of  the  Hospitals,  presented  a  patient 
with  chronic  localized  cedema  of  the  right  upper 
limb.     The  patient  was  a  woman,  59  years  of 
age,  syphilitic      The  swelling  was  first  noticed 
four  years  ago,  and  proceeded  regularly  until,  at 
the  end  of  a  year,  it  attained  its  present  size. 
This  swelling  succeeded  the  disappearance  of  a 
cutaneous  exanthem,  localized  upon  the  same 
limb,  which  she  had  had  for  two  years.     This 
exanthem  had  coincided  with  the  disappearance 
of  the  catamenia.    The  eruption  was  character- 
iz^^d  by  a  series  of  vesicles  which  soon  ulcerated, 
seated  upon  the  back  of  the  hand,  and  accom- 
panied   with   crevasses  at   the  articular  folds. 
The    eruption    was   continuous.       She    subse- 
quently  had  an   attack    of    right   hemiplegia 
which    had    no    influence    upon    the    oedema. 
Movement  slowly  returned.     Under  the  influ- 
ence of  iodine  the  oedema  became  softer,  and 
there  was  some  amelioration.     The  right  upper 
limb  is  the  seat  of  a  white,  soft  oedema,  occu- 
pying the  hand  and  forearm,  but  extending  to 
the  arm.     This  limb  is  more  sensitive  to  cold 
than  the  other.     The  mobility  is  diminished. 
Disagreeable  tinglings  are  occasionally  felt  in 
the  tips  of  the  fingers.     The  palm  of  the  hand 
is  continually  damp,  and  at  times  bathed  with 
an  abundant   perspiration.     Neither  obliterat- 


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ing  clot  nor  compressing  tumour  can  be  felt  in 
the  veins.  No  central,  arterial,  or  nervous 
origin  could  be  discovered  for  the  tcdema.  The 
inferior  limb,  which  was  paralysed,  is  not 
oedematous. — JJ  Union  Medicale, 


Pork  Measle  in  Man. — M.  Troisier  ex- 
hibited lately  to  the  members  of  the  Paris 
Hospitals  Medical  Society  a  man,  36  years 
old,  a  Parisian,  who  for  a  year  past  had 
noticed  small  swellings  arise  on  the  cheeks, 
arms,  legs,  and  abdominal  wall.  These  proved 
to  be  due  to  cysticerci,  and,  curiously  enough, 
the  patient  had  passed  a  tsenia  solium  whilst 
bearing  these  larvje  in  his  body.  M.  T.  sug- 
gested two  hypothetical  explanations  of  this 
coincidence ;  either  that  the  man  had  swal- 
lowed the  ova  of  his  own  tapeworm,  or  that 
cysticerci  and  tapeworm  were  derived  from 
the  same  external  source.  He  asked  what 
treatment  should  be  followed.  No  one  could 
dream  of  removing  them  one  by  one,  but  some 
such  simple  method  as  puncture  with  the 
hypodermic  syringe  might  suffice  to  kill  them. 

HEMORRHOIDS.  Equitation  as  Preventive 
AND  Cure. — In  the  N'ew  York  Medical  Record, 
for  26th  August  last,  Dr.  William  Bodenbamer 
writes  favourably  of  horseback  exercise  as  a 
potent  preventive  and  treatmen  t  for  h  ae  morrh oids, 
especially  internal.  He  also  refers  to  a 
gymnastic  exercise  practised  in  Bethune 
Hospital  with  success  in  this  affection.  "  It 
consists  simply  in  trying  to  touch  the  toes  with 
the  fingers  without  bending  the  knees.  This 
movement  though  difficult  at  first,  soon  be- 
comes easy ;  it  not  only  strengthens  and 
develops  the  muscles  of  the  abdomen,  but  also 
those  of  the  legs  and  thighs."  Perhaps,  too, 
the  posture  and  the  aspiration  exercised  on  the 
contents  of  the  abdomen  may  be  one  factor  in 
the  amelioration. —  Ed. 

Hydatid  Cyst  of  the  Heart. — M.  Arnold 
reports  the  case  of  a  young  man,  21  years  of 
age,  who  had  been  subject  to  fainting  spells — 
heart's  action  energetic  but  the  pulsations 
regular  and  normal, — cyanotic  condition  of  skin, 
without  true  respiratory  embarrassment,  gene- 


ral and  confluent  urticaria,  manifest  tendency 
to  algidity.  The  autopsy  discovered  three 
hydatid  cysts  at  the  apex  of  the  left  lung ;  in 
the  pulmonary  artery  numerous  free  hydatids 
of  all  sizes,  still  more  hydatids  in  the  right 
ventricle.  In  the  right  auricle  a  cystic  tumor 
semi-collapsed  with  an  enlarged  slit-like  open- 
ing towards  the  tricuspid  orifice  and  filled  with 
hydatids  ;  the  liver  and  spleen  contained  no 
cysts. — Gazette  des  Ildp. 


Ileus,  caused  by  Concrktions  of  Gum 
Shellac. — C.  Friedlander. — The  calibre  of 
the  small  intestine  was  completely  occluded  at 
30  centimetres  above  the  ileo-csecal  valve  by 
spherical  and  cylindrical  concretions.  Some,  of 
large  size,  were  even  foimd  in  the  stomach. 
Some  of  them  were  as  large  as  a  goose's  egg. 
The  total  weight  of  the  concretions  was  about 
960  grammes.  They  are  of  a  brown  colour 
and  vitreous  fracture.  The  history  was  that  of 
a  furniture  polisher  addicted  to  alcohol.  He 
satisfied  his  passion  by  consuming  an  alcoholic 
solution  of  gum  hhellac  which  was  used  as  a 
varnish  in  bis  business. — L' Union  Medicale. 

M.  Dubou^  recommends  in  a  paper  addressed 
to  the  Academy  of  Medicine,  the  administra- 
tion of  ergot  of  rye  in  typhoid  fever.  He 
advises  it  be  given  in  substance,  before  eating, 
in  doses,  from  IJ  to  3  grammes  for  adults,  in 
divided  doses  per  diem,  andj'from  0.40  to  1 
gramme  to  children.  The  quantity  to  be 
regulated  by  the  temperature  or  general  con- 
dition of  the  patient.  He  states  that  the 
remedy  is  applicable  at  all  periods,  and  in  all 
forms  of  typhoid  fever,  without  exception. 
In  51  cases  he  had  3  deaths  or  6%. — U  Union 
Medical. 


M.  Gentilhomme,  of  Rheims,  recommends  as 
a  cure  for  a  cold  in  the  head  one  quarter  of  a 
milligramme  of  the  sulphate  of  atropine.  It 
should  be  taken  as  soon  as  possible  after  the 
symptoms  declare  themselves.  In  quarter  of 
an  hour  after  taking  it  the  distressing  symptoms 
begin  to  abate.  If  necessary  in  a  few  hours 
the  dose  may  be  repeated. — U  Union  Mid.  et 
Sci.  du  Nord-Est. 


OF  MEDICAL  SCIENCE. 


331 


cfurgery. 


THE   USE   OF  OXYGENATED   WATER 
IN  SUKGERY— PEAN. 

The  researches  of  M.M.  Paul  Bert  and 
Regnard  on  the  effects  of  oxygenated  water  have 
induced  Drs.  Pean  and  Baldy  of  the  St.  Louis 
Hospital  to  investigate  its  applicability  to 
surgery. 

The  oxygenated  water  made  use  of  was 
prepared  by  Mr.  Baldy,  and  was  perfectly 
neutral  and  contained  from  two  to  twelve  times 
its  volume  of  oxygen,  as  required. 

First  of  all  it  was  applied  externally  for  the 
dressing  of  great  traumatisms  and  divers  ulcers. 
It  was  also  administered  internally  in  certain 
diseases  as  anaemia,  septicaemia,  diabetes, 
tubez'culosis,  and  more  particularly  tuberculrr 
operation  cases. 

Externally  oxygenated  water  was  applied  by 
means  of  compresses  of  tarletan,  covered  with 
sheets  of  oil  silk  to  prevent  evaporation,  and 
retained  with  bandages.  These  applications 
were  renewed  once  or  twice  a  day  according  to 
the  indications,  also  whenever  there  was  a 
discharge  requiring  the  use  of  a  drainage  tube, 
injections  of  oxygenated  water  were  made  at 
each  dressing  thro'  the  orifices  of  these  tubes, 
until  the  fluid  returned  clear  and  frothing. 

So  far  the  results  have  proved  roost  satis- 
factory— they  have  been  favourable  not  only 
in  the  minor  amputations  and  resections 
which  are  daily  performed  in  an  important 
service  such  as  that  of  M.  Pean  at  the  St  Louis, 
but  even  in  the  great  amputations  of  limbs 
(thigh,  leg,  arm,  and  fore-arm).  Oxygenated 
water  has  also  been  applied  after  the  ablation 
of  large  tumours  whether  taken  from  the  soft 
parts  or  the  hard  parts  of  the  limbs  and  from 
the  trunk,  in  incisions  of  multiple,  long  and 
deep  fistulous  tracts,  and  in  grave  accidental 
wounds  complicated  with  severe  lacerations. 
Throughout  the  entire  period  of  the  dressings, 
the  atmosphere  of  the  wounds  has  been  modifi- 
ed by  vaporisations  of  Oxygenated  water. 

Under  the  influence  of  these  applications, 
the  wounds,  those  recently  made  with  bistuury 
or  thermo-cautery,  as  well  as  those  of  older 
date,  covered  with  sphacelated  portions  which 


had  induced  a  certain  degree  of  lymphangitis  or 
erysipelas,  have  quickly  assumed  a  healthy 
aspect  and  become  covered  with  rosy  granula- 
tions, which  have  furnished  a  pus  relatively 
abundant,  but  creamy  an  J  without  odour. 
There  had  been  exceptions  at  first  only  in  those 
covered  with  sphacelated  portions,  and  even  in 
these  cases  the  odour  appeared  less  than  with 
dressings  made  with  other  substances.  We 
have  also  noted  a  favourable  tendency  towards 
union  by  first  intention  of  amputation  wounds 
and  rapid  cicatrisations  of  old  woundg  and 
chronic  ulcers. 

At  the  same  time  in  patients  who  had  been 
treated  by  other  methods  and  who  were  threat- 
ened with  septicaemia,  at  the  moment  we 
began  these  dressings  we  began  its  internal 
administration. 

The  effects  have  appeared  to  us  most  satis- 
factory, not  only  in  view  of  the  local  condition 
but  as  regards  the  general  state.  The  fever 
which  is  declared  after  great  traumatisms  has 
been  moderated,  most  often  at  the  end  of  three 
to  four  days  it  has  completely  subsided  and  we 
have  been  struck  with  the  slight  elevation  of 
pulse  and  temperature. 

All  these  results  have  appeared  at  the  least 
as  satisfactory,  if  not  more  so,  as  those  from 
alcohol  simple  or  camphorated  and  carbolic  acid. 
In  this  respect  should  we  not  prefer  the  oxygen- 
ated water  to  the  last  since .  it  has  neither  the 
toxic  properties  nor  the  vile  odour  of  carbolic 
acid. 

As  to  tubercular  ulcerations  they  have  been 
happily  modified.  In  epithelial  or  sarcomatous 
ulcerations  this  mode  of  dressing  has  not  been 
sufliciently  tried  to  base  an  opinion  of  its 
definitive  action.  But  there  is  reason  for 
thinking  that  it  may  produce  some  modification. 
We  now  replace  the  carbolic  spray  with 
oxygenated  spray  in  all  large  operations  such 
as  gastrotomy. — Gaz.  de&  H6p. 


Dr.  Gustav  Krehbiel,  (in  Wien.  Med.  Woch.,) 
records  the  case  of  a  man,  aged  54,  who  was 
shot  through  the  hand.  The  wound  was 
washed  with  a  5%  solution  of  carbolic  acid. 
The  canal  formed  by  the  bullet  was  then  filled 
with  iodoform.  Healing  took  place  with  scarcely 
a  trace  of  inflammation. 


332 


CANADIAN  JOURNAL 


M.  Pierre  Vigier  finds  from  experiments 
upon  himself  and  upon  his  pupils  that  sub- 
stances incorporated  with  glycerine  are  not 
absorbed  by  the  skin,  therefore,  he  advises 
as  a  parasiticide  the  substitution  for  blue 
ointment  which  stains  the  linen  and  is  ab- 
sorbed, a  glycerine  thus  composed  :  Corrosve 
sublimate,  5  gr.,  glycerine  (English  or  Prices') 
100  gr.  In  spite  of  the  causticity  of  the 
bichloride  the  skin  is  not  irritated  by  this  mix- 
ture, and  after  extensive  applications  to  the 
skin  no  mercury  is  found  in  the  urine. — 
L^  Union  Medical. 

BoRAcic  Acid  as  an  Antiseptic  in  Skin 
Diseases. — Messrs.  Savoy  and  Moore's  chem- 
ist recommends  that  boracic  acid  should  be 
dissolved  in  glycerine,  and  this  solution  incor- 
porated with  fatty  bases  of  white  wax  and 
almond  oil  (not  vaseline)  to  produce  a  soft, 
homogeneous,  creamlike  compound,  free  from 
all  the  usual  sharp-edged,  irritating,  crystalline 
plates  of  boracic  acid,  which  are  s)  hard  to 
reduce  to  an  impalpable  powder. — Practitioner 
— Archives  of  Dermatology. 

Gynocardic  Acid  and  Chaulmoogra  Oil. — 
Wyndham  Cottle  prefers  the  acid  to  the  oil 
wherever  there  is  malnutrition,  as  in  gout  and 
rheumatism,  late  syphilis,  &c.  He  gives  half 
grain  dose  of  the  acid  with  extract  of  gentian, 
hops,  or  conserve  of  roses  several  times  a  day ; 
and  has  exhibited  3  grains  daily  for  four 
months.  Locally  in  eczema  the  following  is  a 
very  useful  ointment :  R.  acidi  gynocard,  gr. 
xv-xxv ;  vaseline,  gj. 


Winiwarter,  in  Wien.  Med.  Woch.,  gives  the 
history  of  a  case  where  the  ductus  choledochus 
became  obliterated.  In  three  weeks  the  gall 
bladder  had  attained  an  enormous  size,  and 
there  was  intense  jaundice.  Aspiration  of  the 
contents  of  the  gall  cyst  failed,  and  he  deter- 
mined to  establish  a  fistulous  opening.  This 
was  successful,  and  the  patient  made  a  good 
recovery. 


Dr.  Markham,  of  Australia,  in  Wien.  Med. 
Woch.,  states  the  following  treatment  for  fistula 


in  ano : — The  fistula  is  first  enlarged  by  sponge 
pressui'e,  the  sphincter  is  well  stretched  and 
opium  administered  to  secure  about  five  days 
rest.  The  fistula  is  then  carefully  plugged 
with  charpie  dipped  in  a  mixture  of  carbolic 
acid  and  glycerin  one  to  eight.  Healing  took 
place  in  his  cases  in  from  throe  to  six  weeks. 

HiP-JoiNT  Amputations. — Within  a  month 
three  striking  instances  of  the  value  of  Mr. 
Davey's  lever  in  this  operation  have  occurred  in 
England.  A  case  operated  on  by  Mr.  Mc- 
Lai'en,  of  Carlisle,  lost  only  two  ounces  of 
blood ;  one  under  Mr.  Cowell's  care  at  the 
Westminster  Hospital  lost  three  ounces ;  and 
a  third  operated  on  by  Mr.  Paul  Swain,  of 
Plymouth,  lost  but  one  ounce  and  a-half. 

Ammonio  Mercuric  Peptone  in  Syphilis. 
— M.  Martin  eau,  says  the  N.  Y.  Medical 
Record,  has  treated  600  syphilitic  patients  by 
subcutaneous  injections  of  ammonio-mercuric 
peptone.  He  has  made  11,000  injections  in 
all,  and  has  never  had  any  accident  :  neither 
abscess,  stomatitis,  salivation,  nor  intestinal 
disorder. 

Tarnier's  Method  of  Preventing  Puer- 
peral Infection. — "Even  in  1856,  when  I 
was  Interne  at  the  Maternity  Hospital,  the 
mortality  was  five  per  cent.,  this  is  now 
reduced  to  two  per  cent,  in  hospital,  and  three 
quarters  of  one  per  cent,  in  the  pavilion  I  had 
constructed  a  few  years  ago.  Each  patient 
there  has  a  separate  room,  entered  from  with- 
out, so  that  a  nurse  can  only  pass  from  one  to 
another  by  going  outside  into  the  open  air. 
The  furniture  is  of  japanned  iron  ;  the  floors, 
walls,  and  ceilings  are  of  impermeable  concrete. 
The  mattresses  and  pillows  are  stuffed  with  cut 
chaff",  which  is  burnt  after  use  in  every  single 
case.  Instead  of  Mcintosh  sheets,  one  of 
brown  paper  made  impermeable  by  pitch,  is 
used ;  this  is  burnt  after  use."  For  the 
washing  of  the  genitals  he  uses  weak  solutions 
of  bichloride  of  mercury,  being  the  best  and 
most  powerful  germicide, 


OF  MEDICAL  SCIENCE. 


333 


THE  CANADIAN 

huul  of  |yi(iti  himt, 

A  Uontlily  Journal  of  Medical  Science,  CriticiBm, 
and  News- 

To  Correspondents. —  IVe  shall  be  glad  to  re- 
ceive from  our  friends  everywhere,  current  meaical 
news  oj  general  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwarduis^  reports  of  the  proceedings  of  their 
Associations 

TORONTO,  OCTOBER,  1882. 

MEETING  OF  THE  CANADA  MEDICAL 
ASSOCIATION. 

The  meeting  of  tbis  Association,  held  in 
Toronto,  on  the  6th,  7th,  and  8th  of  September, 
was  both  a  pleasant  and  a  successful  one.  A  re- 
union of  medical  men  who  take  a  deep  interest 
in  both  the  scientific  and  practical  departments 
of  our  profession  is  always  very  enjoyable,  and 
this  year's  congress  was  no  exception  to  that 
rule.  The  words  quoted  by  our  worthy  and 
respected  President,  "  happy  to  meet,  sorry  to 
part,  happy  to  meet  again,"  are  literally  true, 
and  we  can  add  but  little  to  them.  It  is  a  real 
pleasure  to  see  the  old  familiar  faces,  to  grasp 
the  friendly  hand,  to  recall  many  pleasant  re- 
miniscences of  the  past,  and  at  the  same  time 
to  form  new  friendships,  which  it  is  hoped,  will 
be  as  pleasurable  and  profitable  in  the  future 
as  those  gone  by. 

Apart  Irom  these  considerations  such  gather- 
ings are  a  source  of  great  profit,  both  directly 
and  indirectly,  to  those  who  have  the  privilege 
of  attending  them.  From  such  intercourse 
with  friendly  and  zealous  peers  we  must  of 
necessity  get  some  new  ideas  and  inspirations 
which  will  do  much  to  prevent  us  from  getting 
into  the  wretched  groove  of  an  unscientific  and 
almost  mechanical  routine  which  is  oftentimes 
disastrous  for  both  practitioners  and  patients. 

The  interest  of  this  meeting  was  well  sus- 
tained from  beginning  to  end.  The  large 
number  of  papers  created  a  necessity  for  divi- 
sion into  sections,  medical  and  surgical,  and 
there  was  ample  work  for  both.  The  reports 
of  committees  were  unusually  able  and  inter- 
esting.    In  all  cases  special  subjects  of  interest 


were  treated,  and  the  readings  generally  elicited 
free,  and  sometimes,  rather  racy,  discussions. 
We  take  pleasure  in  publishing  two  of  them, 
"  Medicine,"  and  "  Surgery,"  in  this  issue,  and 
hope  to  give  others  hereafter. 

THE   EEPORT   ON   MEDICINE. 

Dr.  Graham,  just  returned  from  the  land  of 
Pathology,  read  this  report  in  which  he  dealt 
principally  with  the  subject  of  tuberculosis.  A 
short  account  was  given  of  the  various  dis- 
coveries made  in  this  subject,  from  the  time  of 
Laennec  up  to  the  present.  A  description  was 
then  given  of  the  bacilli  of  tuberculosis  as  dis- 
covered by  Koch,  as  well  as  of  Ehrlich's  im- 
proved method  of  staining.  Some  specimens  of 
the  bacilli  were  shown  in  the  museum  stained 
according  to  Ehrlich's  method. 

THE    REPORT    ON   SURGERY 

Was   read  by  Dr.  Shepherd  who    book  up    the 

following  subjects  : — Treatment  of  wounds,  in- 
flammation, sponge  grafting,  bone  transplanta- 
tion, surgery  of  the  kidney  and  joints,  and  treat- . 
raent  of  club  foot.  His  remarks  on  the  treat- 
ment of  wounds  gave  rise  to  an  able  discussion. 
He  showed  cleirly  the  proper  relations  existing 
between  Listerism  and  the  broad  subject  of 
antisepticism,  and  while  giving  due  credit  to 
Lister,  for  the  wonderful  work  he  has  accom- 
plished, expressed  his  own  preference  for  treat- 
ment by  rest,  support,  and  infrequent  dressings, 
together  with  the  use  of  iodoform.  We  con- 
sider this  method  of  treatment  to  be,  at  least, 
equally  efficacious,  although  less  brilliant,  less 
impressive,  and  less  troublesome,  while  at  the 
same  time  it  possesses  the  unspeakable  ad- 
vantage of  being  always  available,  always 
practicable,  whether  in  the  largest  and  best- 
ordered  hospital,  or  in  the  smallest  cabin  in 
our  backwoods.  And  so  apparently  thought 
the  majority  of  the  members  present. 

THE    RECEPTION    BY    THE    PROFESSION 
OF  TORONTO. 

We  were  glad  to  see  such  an  unanimous  effort 
on  the  part  of  the  Torontonians  to  entertain 
our  guests  as  hospitably  as  time  and  circum- 
stances would  permit.  The  formal  reception 
took  the  shape  of  a  conversazione,  which  was 
held  in   the  rooms  of  the  Education   Depart- 


334 


CANADIAN  JOURNAL 


ment,  on  the  evening  of  the  second  day,  and 
was  in  every  respect  one  of  the  most  successful 
entertainments  of  the  kind  ever  given  in  To- 
ronto. As  indicated  in  our  last  issue  the  address 
of  welcome  was  delivered  by  Dr.  Workn)an 
with  his  usual  felicity,  to  which  a  hapjjy  reply 
was  made  by  the  President  of  the  Association, 
Dr.  Fenwick,  of  Montreal.  Those  present  had 
also  the  unexpected  pleasure  of  listening  to  a 
short  address  from  the  distinguished  scientist? 
Dr.  W,  B.  Carpenter.  The  music  was  all  that 
could  be  desired,  and  the  songs  of  the  Misses 
Hillary,  Miss  Berryman,  Mens.  Pernet,  to- 
gether with  the  performance  on  piano  and 
violin,  by  the  Drs.  Geikie,  were  highly  ap()re- 
ciated. 

In  speaking  of  the  work  done  by  the  Com- 
mittee of  Arrangements,  we  must  refer  es- 
pecially to  the  untiring  efforts  of  its  able  and 
energetic  Chairman,  Dr.  Canniff,  in  whom  was 
combined  the  wisdom  of  the  experienced,  with 
the  zeal  of  the  youngest  enthusiast.  In  making 
the  preparations  for  the  conversazione,  he  was 
ably  assisted  by  Dr.  May,  of  the  Education 
Department  and  others 

Dr.  Daniel  Clark  entertained  the  membera 
of  the  Association  at  a  most  recherche  luncheon 
on  the  third  day.  It  happened,  unfortunately, 
that  many  were  unnble  to  remain,  although 
very  anxious  to  do  so.  A  goodly  number,  how- 
ever, were  present,  including  a  few  ladies,  and 
enjoyed  themselves  immensely  in  inspecting 
and  discussing  both  the  admirable  arrange- 
ments and  working  of  the  institution  and  the 
good  things  provided  on  the  table.  Mr. 
Attorney-General  Mowat,  Dr.  W.  T.  O'Reilly, 
Dr.  Workman,  Dr.  Daniel  Clark,  and  Dr. 
Grant,  each  made  an  appropriate  and  happy 
speech,  and  the  gathering  dispersed  with  the 
conviction  that  the  last  was  by  no  means  the 
least  enjoyable  feature  of   the  meeting  of  1882. 


Prof.  Chiara,  of  Milan,  has  succeeded  the 
renowned  V.  Ballochi  in  the  Chair  of  Obstetrics 
at  Florence.  Porro,  of  Pavia,  has  taken 
Chiara 's  place ;  and  the  latter's  assistants, 
Mangiagalli  and  Negri,  have  been  appointed 
to  the  Obstetrical  chairs  in  Sassari  and 
Novare,  reppectively. 


Dr.  Henry  H.  Reeve,  of  Minesing,  has  pur- 
chased the  practice  of  Dr.  Lund,  of  Churchhill, 
and  the  latter  has  removed  to  Guelph. 


THE  INTERMEDIATE  EXAMINATION 
AND  MATRICULATION  FOR  THE 
MEDICAL  COUNCIL. 

We  find  by  the  circular  recently  issued  by 
the  Minister  of  Education,  that  important 
changes  are  to  be  instituted  in  the  Intermediate 
Examinations,  which  will  materially  lower  its 
standard  ;  but  the  Executive  Committee  of  the 
Council,  after  conferring  with  the  Head  of 
the  Department,  received  the  assurance  that 
the  programme  would  be  so  arranged  that 
candidates  for  matriculation  maybe  examined  in 
all  the  subjects  required  by  the  Council.  The 
Registrar  has,  therefore,  issued  the  following 
circular  : — "  The  Intermediate  Examination 
referred  to,  *  *  *  as  the  Matriculation  Exam- 
ination, includes  the  following  subjects,  all  of 
which  are  compulsory  : — English  Grammar, 
English  Literature,  Composition,  Dictation, 
Arithmetic,  Algebra  and  Euclid,  History, 
Geography,  and  Latin." 

As  will  be  seen  by  reference  to  the  circu- 
lar in  question,  Algebra  and  Euclid,  History 
and  Geography,  have  been  removed  from  the 
list  of  compulsory  subjects,  and  placed  among  the 
optional,  with  Latin  and  other  subjects. 

We  believe  the  Profession  of  Ontario  will 
almost  unanimously  feel  both  surprised  and 
disappointed  at  this  sudden  and  unexpected 
change,  which  makes  the  intermediate  simply 
the  examination  for  graduation  in  the  com- 
mon scht  ols,  and  places  matriculation  in 
medicine  on  a  par  with  entrance  into  the 
high  schools.  It  will  become  the  duty  of  the 
Council  to  seriously  consider  the  question, 
and  we  see  no  course  open  except  at  onco  to 
cut  all  connection  with  an  examination  which 
practically  includes  in  its  compulsory  list  only 
English  Grammar,  and  Arithmetic.  The  one 
would  of  course  enable  a  Medical  Practitioner 
to  write  out  tlie  directions  for  the  preparation 
and  application  of  a  slip[)ery-elm-bark  poultice, 
while  the  other  would  make  him  competent  to 
give  back  the  right  change  when  settling  with 
his  paying  patients,  but  taken  together  they 
scarcely  come  up  to  the  high  standard  of  pre- 
liminary education  for  our  Profession  which 
so  many  are  contending  for. 


Dr.  Pirrie,  Professor  of  Surgery,  at  Aberdeen, 
has  resigned  after  52  years'  service,  9  spent  in 
the  Chair  of  Anatomy  and  Physiology,  and  43 
in  that  of  Surgeiy.  Dr.  Alex.  Ogston  is  spoken 
of  as  his  successor. 


OF  MEDICAL  SCIENCE. 


335 


ADDKESS  TO  STUDENTS. 

{From  London  Lancet.) 
THE  MEDICAL  CURRICULUM. 

The  conjunction  of  a  sound  mind  with  a 
sound  body  is  an  indispensable  condition  of  the 
successful  study  and  practice  of  medicine.  A 
clear  intellect  and  a  quick  understanding  are 
indeed  necessary,  but  they  will  not  suffice.  The 
study  of  medical  science  requires  considerable 
mental  powers ;  but  medical  practice  has  heavy 
bodily  tasks  that  none  but  strong  men  can  per- 
form, and  none  but  strong  men  should  attempt. 
Without  a  sound  constitution  and  robust  health, 
the  medical  student  and  practitioner  will  sooner 
or  later  find  they  must  narrowly  circumscribe 
their  spheres  of  activity.  The  health-qualifica- 
tion is  not  sufficiently  considered  by  some  of 
those  who  enter  the  ranks  of  the  medical  pro- 
fession. It  is  only  when  the  constitution  is  un- 
dermined, the  health  broken,  and  the  energies 
exhausted  by  the  hardships,  the  exposures,  the 
anxieties,  and  the  constant  application  of  mind 
and  body  under  unfavourable  and  depressing 
conditions  that  its  importance  is  fully  appre- 
ciated. It  is  then  often  too  late  to  correct  the 
error.  The  whole  life,  training,  aspirations,  and 
interests  are  staked  in  the  enterprise,  and  to  be 
compelled  to  withdraw  is  an  acknowledgment 
of  defeat  and  failure.  Those  who  are  now  con- 
templating starting  on  the  medical  career  should 
assure  themselves  they  are  endowed  with  bodily 
strength  and  activity  commensurate  with  the 
demands  that  are  likely  to  be  made  upon  them 
in  after-life. 

Next  to  a  sound  body,  the  qualification  for 
the  successful  pursuit  of  the  science  and  art  of 
medicine  is  a  cultivated  understanding.  In 
some  degree  this  is  provided  for  by  a  preliminary 
examination,  but  this  security  is  not  enough. 
The  general  education  should  be  the  best  at- 
tainable, both  as  regards  thoroughness  and  ex- 
tent. By  this  we  do  not  mean  the  student 
should  have  an  elaborate  acquaintance  with  any 
particular  form  or  department  of  learning, 
whether  classical  or  scientific,  but  rather  that 
he  should  be  carefully  trained  and  disciplined 
in  every  useful  mental  and  moral  exercise. 
Much  has  been  said  in  favour  of  what  is  called 
"  a  university  education  "  for  all  medical  stu- 
dents ;  but  experience  has  shown  this  is  not  an 


unqualified  benefit.     "While  it  is  desirable  that 
every  medical  man  should  be  an  accomplished 
gentleman,  as   well   as   a   skilful  practitioner, 
great  scholastic  attainments  do  not  necessarily 
imply   special   aptitude    for   medical    practice. 
Those  who  have  obtained  a  degree  in  arts  before 
they  begin  medical  studies,  have  passed  the  time 
when  they  can  readily  apply  themselves  to  the 
rudiments  of  their  technical  training,  or  have 
acquired  an  intellectual  starchness  that  prevents 
them  from  stooping  to  the  fancied  drudgery  of 
such  rudiments.     Any  youth  of  average  talents, 
whose  education   is   conducted   by   competent 
masters,  may    acquire    an    amount  of  general 
knowledge  and  mental  discipline  equal  to  the 
demands  of  any  department  of  medical  science. 
It   is,  how«ver,  desirable   that  the  student 
should  have  correct  notions  of  the  meaning  and 
object   of  education.     The   medical    education 
is    almost    wholly    technical,    though,  unlike 
some    other  forms  of  technical   training,  it  is 
capable  of  ultimately  being   transformed  into 
culture.       Despite    the     tendency   of    current 
opinions,  it  should  not  be  assumed  that  educa- 
tion means  mere  knowledge,  or  learning,  or  the 
giving  and  receiving  of  instruction.     It  means, 
rather,  in  Milton's  words,   "  that  which  fits  a 
man  to  perform  justly,  skilfully,  and  magnani- 
mously, all  the  offices,  both  public  and  private, 
of  peace  and  war."     The  prevalence  of  the  doc- 
trines of  the  utilitarian  philosophers  has  done 
much  to  foster  false  and  erroneous  opinions  of 
the  end  and  purpose  of  education.     Knowledge, 
not  wisdom,  has  become  the  approved  end  of 
education,  and  cleverness  in  examination  rather 
than  the  skilful   management  of  the  aflfairs  of 
life,  the  final  test  of  success.     The  best  minds 
have  in  all  ages  protested  against  this  specious 
doctrine.     Rabelais,  MontaigLe,  Milton,  Locke, 
and  others,  have  denounced  it.     "  The  greatest 
clerks  are  not  the  wisest  men,"  said  Rabelais, 
and  our  Cowper  differentiates  the  tendencies  of 
these  two  schools  in  his  lines  : — 

"  Knowledge,  and  Wisdom,  far  from  being  one, 
Have  ofttimes  no  connexion.     Knowledge  dwells 
In  heads  replete  with  thoughts  of  other  men  ; 
Wisdom  in  minds  attentive  to  their  own. 
Knowledge  is  proud  that  he  has  learnt  so  much  ; 
Wisdom  is  humble  that  he  knows  uo  more." 

As  education  does  not,  therefore,  consist  exclu 
sively  or  solely  of  the  acquisition  of  knowledge, 


336 


CANADIAN  JOURNAL 


but  includes  the  complete  and  harmonious  de- 
velopment of  all  the  mental  and  bodily  faculties, 
the  exercise  and  training  of  the  natural  senses 
should  not  be  disregarded.  In  this  age,  when 
progress  in  applied  seience  depends  chiefly  upon 
the  elaboration  of  apparatus  and  instruments, 
when  the  conquests  of  therapeutics  over  path- 
ology depend  mainly  upon  the  perfection  of  the 
physical  aids  to  diagnosis,  there  is  some  risk  of 
ruining  the  natural  senses  by  the  exclusive  use 
of  instruments.  Kant  foresaw  this  danger 
more  than  a  century  ago,  and  uttered  a  note  of 
warning  against  it.  The  stethoscope,  the  ther- 
mometer, the  sphygmograph,  the  ophthalmo- 
scope, and  the  laryngoscope,  have  enlarged  our 
powers  of  diagnosis,  but  it  is  doubtful  whether 
they  have  extended  our  usefulness  as  practi- 
tioners of  the  healing  art  in  a  corresponding  de- 
gree. "Without  these  aids  the  modern  practi- 
tioner is  often  helpless,  where  his  forefather, 
prompted  by  the  dictates  of  a  trained  experience, 
would  have  struck  boldly,  and  struck  to  good 
purpose. 

However  large  the  amount  of  instruction 
imparted  in  the  medical  curriculum  may  be,  the 
medical  student  and  practitioner  who  shall  be 
worthy  of  their  calling  must  be  in  a  large 
measure  self-taught.  The  student  must  see, 
hear,  handle,  think,  and  judge  for  himself.  His 
knowledge  and  his  experience  must  be  organ- 
ically assimilated,  and  not  merely  mechanically 
stored  within  his  memory.  Now,  more  than 
in  any  previous  period,  the  student  is  in  danger 
of  too  much  didactic  teaching,  or,  as  Locke 
would  say,  "of  being  magisterially  dictated  to 
what  he  is  to  observe  and  follow."  Nearly 
three  hundred  years  ago  Montaigne  condemned 
excessive  tutorship  :  "  'Tis  the  custom  of  peda- 
gogues to  be  eternally  thundering  in  their 
pupils'  ears,  as  if  they  were  pouring  into  a 
funnel,  whilst  the  business  of  the  pupil  is  only 
to  repeat  what  the  teacher  has  said."  This 
"  thundering  in  the  ears  of  pupils  "  may  secure 
success  in  examination,  but  it  will  never  bring 
that  Knowledge  which  is  Power,  While  then 
the  pupil  must  in  many  things  deliver  himself 
up  to  the  influence  of  authority,  he  must  ever 
n  member  that  he  can  only  know  through  his 
own  understanding.  Though  lectures  and  book- 
reading  will  do  much  for  him,  they  will  not  do 


all ;  they  will  not  do  even  enough.  The  rest 
he  must  accomplish  for  himself.  He  must 
meditate  upon  what  he  hears  and  sees  ;  he  must 
reflect,  test,  and  verify  continually.  There  is 
no  better  way  than  diligent  attendance  on  well- 
conducted  class-examinations,  self-questionings, 
and  discourse  with  judicious  friends.  On  this 
matter,  Locke,  whose  "Thoughts  on  Education" 
every  one  should  read,  has  some  wise  words. 
"  Reading,"he  says,  "  is  but  collecting  the  rough 
materials,  amongst  which  a  great  deal  must  be 
laid  aside  as  useless.  Meditation  is,  as  it  were, 
choosing  and  fitting  the  materials,  framing  the 
timbers,  squaring  and  laying  the  stones,  and 
raising  the  building ;  and  discourse  with  a 
friend  (for  wrangling  in  a  dispute  is  of  little 
use)  is,  as  it  were,  surveying  the  structure, 
walking  in  the  rooms,  and  observing  the  sym- 
metry and  agreement  of  the  parts,  taking 
notice  of  the  solidity  and  defects  of  the  works, 
and  the  best  way  to  find  out  and  correct  what  is 
amiss ;  besides  that,  it  helps  often  to  discover 
truths,  and  fix  them  in  our  minds  as  much  as 
either  of  the  other  two." 

There  is  one  fact  that  the  student  should 
always  bear  in  mind — that  the  great  bulk  of 
his  duty  in  after-life  will  have  reference  to 
cases  and  conditions  that  cannot  be  considered 
heroic  or  sensational,  but  which  are  the  chief 
care  of  general  practice,  as  they  constitiite  the 
bulk  of  human  trouble.  In  regard  to  this 
great  point  we  should  say  these  two  things  : 
First,  no  case  of  disease,  or  feature  of  disease, 
should  be  despised  for  its  commonness  ;  and, 
secondly,  that  the  more  specific  and  definite 
the  knowledge  that  can  be  gathered  by  a 
student  on  the  conim'm  cases  and  facts  of  dis- 
ease, the  better  practitioner  will  he  turn  out 
in  the  end.  Nine  students  out  of  ten  are  des- 
tined not  to  be  specialists.  General  practice 
is  to  be  their  field  of  labour,  and  there  is  no 
better  field  for  usefulness,  and  even  for  distinc- 
tion. No  man  is  more  valued  in  a  community 
than  the  man  who  is  helpfiil,  and  wise,  and 
kind  in  all  the  emergencies  of  disease,  from  a 
toothache  to  a  puerperal  pyrexia.  But  though 
most  students  are  to  be  general  practitioners, 
their  ultimate  efticiency  and  success  will  depend 
very    nv>ch  on  the   amount  of  special   know- 


OF  MEDICAL  SCIENCE. 


337 


ledge  which  they  can  bring  into  general  prac- 
tice. Where  one  practitioner  must  be  always 
sending  his  patients  off  to  a  specialist,  another 
will  be  special  enough  in  his  knowledge  to 
save  his  own  credit  and  his  patients'  time  and 
money.  In  order  that  the  student  may  thus 
develop  the  greatest  efficiency  and  credit  as  a 
practitioner,  he  must,  after  gaining  a  substan- 
tial knowledge  of  anatomy  and  physiology — 
without  which  all  practice  is  a  sort  of  quack- 
ery,— take  the  best  opportunities  of  seeing 
common  disease,  and  bring  to  its  study  unre- 
mitting attention.  A  cough,  a  rigor,  a  urinary 
deposit,  a  temperature  in  slight  excess  of  the 
normal,  a  rash  on  the  skin,  the  peevishness  of 
a  teething  child,  and  remedies  which  a  good 
practitioner  uses  in  such  cases,  must  have  as 
much  interest  for  him  as  a  strangulated  hernia, 
a  glaucoma,  or  a  case  of  myxcedema.  Happy 
the  student  who  accepts  gratefully  and  yet  with 
independent  and  even  critical  intelligence  the 
best  teaching  of  the  best  practitioners,  whether 
general  or  special.  Medical  practice  to  him 
will  be  a  joy  rather  than  a  care,  and  if  he  be 
occasionally  in  trouble,  like  other  men,  it  will 
not  be  that  greatest  of  all  troubles — conscious 
incapacity  for  common  duties  born  of  inatten- 
tion to  common  cases  and  common,  though 
passing,  opportunities  of  education.  His  des- 
tination may  be  to  practise  in  a  remote  hamlet 
or  the  distant  colony  of  an  extended  empire. 
On  an  emergency  he  may  find  himself  con- 
fronted in  such  a  solitude,  and  at  midnight, 
with  a  case  of  ineffectual  labour,  or  the  still 
more  trying  one  of  retention  of  urine,  and  in 
the  happy  and  timely  use  of  his  forceps  or  his 
catheter,  in  the  relief  of  an  agonized  patient, 
and  in  his  own  consciousness  of  serviceabless, 
he  will  have  reward  enough,  to  say  nothing  of 
the  greater  rewards  which  accrue  to  faithful 
and  religious  men. 


PERSONAL. 

Drs.  W.  T.  Aikins  and  C.  W.  Covernton,  of 
this  city,  return  home  from  Europe  in  the  be- 
ginning of  the  month.  The  latter  gentleman 
represented  the  Provincial  Board  of  Health  of 
Ontario,  at  the  International  Congress  of 
Hygiene  held  last  month  at  Geneva. 


g00fe  |l0tifeisi. 


TJie  Early  Diagnosis    of  Chronic   Bright's 
Disease.  By  T.  A,  McBride,  M.D.,  New  York. 


Li/e  of  John  M.  Briggs,  of  Bowling  Green, 
Ky.  By  W.  K.  Bowling,  M.D.  (Reprint  from 
Nashville  Jour,  of  Med.  and  Surgery. ) 


The  Female  Perineum.  By  T.  G.  Comstock, 
M.D.,M.O.Vien.,  St.  Louis.  (Reprint  from  St. 
Louis  Clinical  Review.) 

The  Multum  in  Parvo  Reference  and  Dose 
Book.  By  C.  Henri  Leonard,  M.A.,  M.D. 
Detroit:  The  Illustrated  Medical  Journal  Co. 

Weekly  Health  Bulletins  and  Meteorological 
Reports  for  the  Months  of  July  and  August. 
Issued  by  the  State  Board  of  Health  of 
Michigan. 


The  Antiseptic  Treatment  oj  Wounds,  after 
Operations  and  Injuries.  By  T.  W.  Briggs, 
M.D.  (Reprint  from  Nashville  Jour.  Med.  dh 
Surg.) 

On  the  Nomenclature  and  Classification  of 
Diseases  of  the  Skin.  By  L.  Duncan  Bulkley, 
A.M.,  M.D.  (Reprint  from  Archives  of  Der- 
matology.) 


The  Malignity  of  Syphilis.  With  an  analysis 
of  450  Cases.  By  L.  Duncan  Bulkley,  A.M., 
M.D.  (Reprint  from  Trans.  Med.  Soc,  State 
of  New  York,  1882.) 


The  Presence  of  the  Micrococcus  in  the  Blood 
of  Malignant  Measles :  Its  Importance  in  Treat- 
ment. By  John  M.  Keating,  M.D.  (Reprint 
from  Phila.  Med.  Times.) 

The  Prescription  of  Proprietary  Medicines 
for  the  Sick :  Its  Demoralizing  Effects  on  t/ie 
Medical  Profession.  An  essay.  By  C.  A. 
Lindsley,  M.D.,  New  Haven,  Conn. 


On  the  Contintums  Inhalation  of  the  Vapour 
of  Slaking  Lime  in  the  Treatment  of  Mem- 
branous Laryngitis.  By  E.  F.  Cordell,  M.D. 
Baltimore :  (Reprint  from  Maryland  Med.  Jour. 


338 


CANADIAN  JOURNAL 


Ninth  Annual  Report  of  the  Secretary  of  the 
State  Board  of  Health,  of  the  State  of  Michi- 
gan, for  the  fiscal  year  ending  30<A  Sept., 
1881. 

The  first  part  of  this  volume  contains  the 
Secretary's  Report  of  the  work  of  the  Board, 
its  sessions,  special  reports,  communicHtions, 
(fee,  and  the  second,  forty-eight  addresses, 
papers,  and  reports  on  sanitary  subjects,  the 
majority  read  at  Sanitary  Conventions  held  at 
Flint  and  Battle  Creek ;  the  balance  being 
ppecial  contributions.  A  large  portion  of  the 
sanitary  field  is  covered  by  these  communica- 
tions ;  and  the  volume,  therefore,  contains  a 
vast  amount  of  instructive  matter,  and  consti- 
tutes an  excellent  ensample  for  our  own  and 
other  local  boards  advantageously  to  emulate. 


Popular  Science  Monthly.     New  York  :  D.  Ap- 

pleton  &  Co. 

The  October  number  of  this  delightful  and 
well-conducted  journal  for  the  enlightenment  of 
the  masses  and  the  popularization  of  scientific 
subjects,  has  come  to  hand.  The  subjects 
treated  of,  which  are  more  especially  interesting 
to  medical  readers,  are  : — Massage,  by  Dr, 
Douglas  Graham  ;  Literature  a?  d  Science,  by 
Matthew  Arnold ;  Mozely  on  Evolution,  by 
Herbert  Spencer  ;  the  Utility  of  Drunkenness, 
by  Matthieu  Williams  ;  Delusions  of  Doubt,  by 
M.  B.  Bill  ;  Physiognomic  Curiosities,  by  Felix 
Oswald,  M.D.;  The  Formation  of  Saline 
Mineral  Waters,  by  M.  Dieulafait;  and  a 
Sketch  (with  portrait)  of  Rudolph  Virchow, 
We  know  of  no  periodical  better  suited  for  the 
delectation  of  a  physician's  family,  or  so  much 
in  place  as  on  his  table. 


Essentials  of  Vaccination:  A  Compilation  of 
Facts  relative  to  Vaccine  Inoculation,  and 
its  Influence  in  the  Prevention  of  Smallpox. 
By  W.  A.  Hardaway,  M.D.,  St.  Louis. 
Chicago  :  Jansen,  McClurg  &  Co.,  1882. 

Dr.  Hardaway  has  done  good  service  in  the 
publication  of  this  little  brochure  of  some  140 
pages.  As  is  asserted  in  the  preface,  the  work 
is  a  mere  compilation,  but  the  profession  should 
feel  greatly  indebted  for  much  valuable  scat- 
tered information  thus  brought  together  and 
rendered  easily  accessible.  Chapter  i.  treats 
briefly  of  the  History  of  Vaccination  ;  chap.  ii. 


of  Variola  in  Animals  ;  chap.  iii.  of  the  Nature 
of  Vaccinia,  in  which  the  conclusion  favoured 
seem  to  be  a  plausible  one,  in  view  of  recent 
knowledge,  that  the  vaccine  matter  is  merely 
the  contagium  of  smallpox  modified  by  trans- 
mission through  the  cow.  Chap.  iv.  deals  with 
Vaccinia  in  the  Human  Subject ;  chap.  v.  with 
Abnormal  Modifications  and  Complications  of 
Vaccinia  ;  chap.  vi.  with  Re- vaccination  ;  the 
view  is  expressed  that,  under  circumstances  of 
exposui'e.  Vaccination  ought  to  be  repeated  at 
any  time  ;  under  ordinary  circumstances,  the 
author  accepts  Trousseau's  advice  of  regarding 
five  years  as  the  limit  of  safety.  Chap.  vii.  dis- 
cusses the  merits  of  the  difi"erent  kinds  of  Vac- 
cine Virus ;  and,  on  the  whole,  the  bovine 
source  is  preferred.  Chap  viii.  details  the 
Methods  of  Obtaining  and  Storing  Vaccine 
Virus.  Chap.  ix.  deals  with  the  Operation  of 
Vaccination,  and  insists  upon  thoroughness  and 
care,  pointing  out,  with  Mr.  Marson,  that  it  is 
as  bad  to  die  from  smallpox  in  consequence  of 
badly-performed  Vaccination,  as  from  any  other 
ill-done  operation.  The  final  chapter  consti- 
tutes an  "  Examination  of  the  Objections  to 
Vaccination,"  and,  of  course,  satisfactorily  dis- 
poses thereof. 


The  Treatment  of  Diseases  by  the  Hypodermatic 
Method.  By  Robeerts  Bartholow,  A.M., 
M.D.,  LL.D.,  4th  Ed.  Revised  and  Enlarged. 
Philadelphia  :  Lippincott  &  Co.,  1882. 
Like  all  of  Dr.  Bartholow's  works  this  book 
is  pleasingly  written  and  well  issued.  It  opens 
with  a  brief  history  of  the  subject,  and  a  de- 
scription of  the  method.  Then  follows  a  list  of 
remedies  administered  by  this  method,  and  an 
account  of  the  local  and  systemic  efiects  of 
subcutaneous  injections  generally.  A  discussion 
of  the  preparation,  dose,  physiological  action, 
accidents,  and  theory  of  each  agent  is  then  pre- 
sented ;  the  major  part  being  occupied,  of  course 
by  the  alkaloids  of  opium  and  belladonna.  But 
duboisia,  strychnia,  curara,  physostigiua, pilocar- 
pine, chloral,  cafiein,  quinia,  mercury,  arsenic, 
(fee, all  receive  due  attention.  We  think  there  can 
be  no  doubt  that  the  author  must  bo  mistaken 
in  the  assertion  that  the  solution  of  apomorphia 
is  spoiled  when  it  turns  green,  which  it  does 
so  rapidly.  We  had  expected  to  find  some 
allusion  to  the  value  of  amyl  nitrite  locally 
administered  in  cramp  or  muscle  spasm  ;  and 
also  to  permanganate  of  potash  in  snake  bite, 
but  find  none. 


OF  MEDICAL  SCIENCE. 


339 


CANADA  MEDICAL  ASSOCIATION. 

The  Association  met  in  Toronto,  on  "Wednes- 
day, 6th  September,  at  10  a.m.,  when  the 
President,  Dr.  G.  E.  Fenwick,  took  the  chair. 
After  the  report  of  the  Committee  of  Arrange- 
ments, past-Presidents  Drs.  Workman,  Botsford, 
Canniff,  and  McDonald  took  seats  beside  the 
chairman.  The  minutes  of  last  meeting  were 
read  and  approved.  It  was  decided  that  the 
President's  address  should  be  read  at  the  even- 
ing session, 

Drs.  Brodie  and  Walker,  of  Detroit,  Elsburg, 
and  Goodwillie,  of  New  York ;  Dr.  Lough,  of 
Bermuda,  and  Dr.  Field,  of  Barbadoes,  were 
elected  members  by  invitation. 

Dr.  W.  B,  Carpenter,  of  London,  England, 
was  present  by  invitation,  and  at  the  request 
of  the  President  delivered  an  address  in  which 
he  took  up  the  subject  of  general  registration. 
He  gave  a  history  of  vital  statistics  in  the 
Mother  Country,  showed  the  great  work  which 
had  been  accomplished  and  urged  the  vast  im- 
portance to  the  Dominion  of  inaugurating  some 
such  system. 

Dr.  Fulton  presented  the  report  of  the  Com- 
mittee on  Necrology,  which  announced  the 
death  of  the  following  physicians  throughout 
the  Dominion  during  the  past  year  : — Dr. 
Berryman,  Toronto  ;  Dr.  T.  Mack,  St.  Cathar- 
ines; Hon.  Dr.  Brouse,  Ottawa;  Dr.  N.  Fleming, 
Mildmay ;  Dr.  H.  Parsley,  Thornbury ;  Dr. 
J.  A.  Purney,  Shelburne,  N.  S.;  Dr.  A,  Robert- 
son, Liverpool,  N.S.  ;  Dr.  W.  G.  Middleton, 
Stella;  Dr.  N.  Munro,  Brucefield ;  Dr.  Mc- 
Micbael,  Gorrie  ;  Dr.  G.  Cook,  Norwich ;  Dr. 
J.  Allen,  Adolphustown ;  Dr.  J.  B.  Smith, 
Jersey ville  ;  Dr.  G.  Lount,  Norwich  ;  Dr.  A.  J. 
Whitehead,  Toronto  ;  Dr.  W.  Philp,  Manilla ; 
Dr.  H.  H.  Bouller,  New  Hamburg  ;  Dr.  W. 
Wilson,  Dorchester,  N.B.  ;  Dr.  J.  P.  Lynn, 
Toronto;  Dr.  C.  W.  Heltz,  Chester,  N.S.;  Dr. 
A.  R.  Lander,  Frankville ;  Dr.  W.  Weir, 
Merrickville  ;  Dr.  H.  Yates,  Kingston  ;  Dr 
H.  Orton,  Ancaster ;  Dr.  McCay,  Blairton ; 
Dr.  Munro,  Montreal ;  Dr.  F.  H.  Wright, 
Toronto  ;  Dr.  H.  Bingham,  Manilla ;  Dr.  A. 
McKay,    Beaverton;     Dr.    G.    W.    Campbell, 


Montreal ;  Dr.  Maxwell,  Bear  River ;  Dr. 
Mcllmurray,  Toronto  ;  Dr.  H.  W.  Lloyd,  Cold- 
stream ;  Dr.  H.  E.  Bissett,  Hawkesbury ;  Dr. 
T.  Blackwood,  Pakenham  ;  Dr.  J.  Salmon, 
Simcoe  ;  Dr.  A.  Greenlees,  Toronto  ;  Dr.  R. 
H.  Wright,  St.  Johns,  Que. 

Dr.  Graham,  then  read  the  report  from  the 
Committe  on  Medicine,  which  appears  in  this 
issue. 

The  following  gentlemen  were  appointed  a 
Nominating  Committee  : — Drs.  Macdonald,  of 
Hamilton  ;  Kennedy,  of  Toronto ;  Sweetland, 
of  Ottawa ;  Rodger,  Cameron,  and  Robillard, 
of  Montreal ;  and  Botsford,  of  St.  John. 


AFTERNOON   SESSION— MEDICAL 
SECTION. 

Dr.  Macdonald,  of  Hamilton,  Chairman.  Dr. 
Stewart,  of  Brucefield,  Ont.,  Secretary. 

ECHINOCOCCUS  DISEASK  IN  AMERICA. 

Dr.  Osier  communicated  the  results  of  an 
inquiry  into  the  prevalence  of  the  affection  on 
this  continent,  and  stated  that  he  had  been 
able  to  collect  from  the  journals  and  private 
sources  61  instances.  Drs.  Temple  and  Graham 
each  narrated  a  case. 

AXIS  TRACTION  AND  TARNIER's  FORCEPS. 

Dr.  Cameron,  of  Montreal,  read  an  elaborate 
paper  on  this  subject,  illustrated  by  diagrams, 
etc.  The  head  followed  the  axis,  and  the 
problem  to  be  solved  was  the  best  means  of 
assisting  nature.  Some  advocated  traction, 
some  leverage,  some  compression,  othei-s  a 
judicious  combination.  He  exhibited  different 
specimens  of  the  forceps,  and  explained  the 
difference  between  the  vis  a  tergo  exerted  by 
nature  and  the  vis  a  fronte  of  the  forceps. 
There  wei  e  three  kinds  of  forceps,  the  straight, 
the  pelvic  curved,  and  the  curved  with  trac- 
tors of  Tarnier.  The  advantage  of  the  straight 
forceps  was  that  they  did  not  interfere  with 
the  natural  rotation  of  the  head,  but  a  great 
disadvantage  was  that  when  the  head  was  high 
up  the  instrument  could  not  fail  to  come  in 
contact  with  the  coccyx.  There  was  also  the 
liability  to  slip  and  injure  the  perineum  and 
soft  parts.  The  curved  forceps  were  less  liable 
to  slip,  but  the  line  of  traction  was  not  in  the 
axis  of  the  pelvis,  and  if  the  instrument  was 


340 


CANADIAN  JOURNAL 


so  adjusled  as  to  bring  the  line  ut  traction 
right,  it  would  be  sure  to  come  in  contact 
either  with  the  symphysis  pub's  or  the  sacrum. 
To  combine  the  advantages  of  these  two  kinds 
of  instruments  and  eliminate  their  disadvant- 
ages, Tarnier  had  invented  his  double  trac- 
tor, which  had  the  advantage  of  action  along 
the  traction  axis  and  at  the  same  time  per- 
mitting the  natural  rotation  of  head.  The 
objections  urged  against  Tarnier's  instrument 
were  its  clumsiness  and  cost  and  the  danger  of 
injuring  the  internal  cavity. 

Dr.  Holmes,  Chatham,  said  he  had  been 
accustomed  to  use  the  forceps  in  the  manner 
recommended  by  Dr.  Albert  Smith,  both  as  a 
lever  and  as  a  tractor.  He  also  found  it 
advantageous  to  advise  the  woman  to  abstain 
from  direct  pressure,  and  he  had  thus  been 
enabled  to  avoid  laceration. 

Dr.  Temple  remarked  that  he  was  not  pre. 
pared  to  concede  all  said  in  favour  of  Tarnier's 
forceps  ;  they  have  not  had  sufficient  use  for 
their  universal  adoption  in  all  cases ;  they  are 
expensive,  cumbersome,  complicated,  and  diffi- 
cult to  keep  clean ;  the  only  advantage  he 
thought  they  have  over  the  doublo  curved  long 
forceps  is  in  posterior  occipital  positions ;  in 
this  position  their  traction  is  very  similar  to 
the  long  straight  forceps,  which  are  much 
more  easy  of  application  in  this  position  than 
the  curved  forceps  and  less  liable  to  slip.  He 
was  much  in  favour  of  simplicity  in  obstetric 
forceps. 

Dr.  Stewart,  of  Brucefield,  could  not  see  the 
advantage  of  Tarnier's  forceps  over  the  older 
forms.  He  hnd  seen  in  Vienna  cases  of  rup- 
ture of  the  vagina  and  death  after  the  use  of 
this  instrument. 

THE  USE  OF  THE    UTERINE    SCOOP  IN   INEVITABLE 
ABORTION. 

Dr.  Alloway,  of  Montreal,  gave  his  experi- 
ence of  the  use  of  this  instrument  in  twenty 
cases.  He  strongly  recommended  its  use  in- 
stead of  the  placental  forceps.  He  criticised 
at  length  certain  of  the  views  on  the  treatment 
of  abortion. 

Dr.  Tye,  of  Chatham,  said  he  really  thought 
they  were  passing  through  the  iron  age  in  the 
matter  of  obstetrics.     After  seeing  all  the  for- 


ceps and  scoops  and  other  iron  instruments,  he 
really  congratulated  himself  that  he  was  not  a 
woman.  In  his  practice  he  relied  chiefly  on 
the  instruments  provided  by  nature,  and  he 
found  them  very  suitable. 

Dr.  Rodger,  of  Montreal,  while  he  disap- 
proved of  undue  multiplicity  and  complication 
of  instruments,  yet  thought  that  the  valuable 
assistance  rendered  by  them  could  not  be  over- 
looked. He  spoke  in  favour  of  the  tampon  and 
placental  forceps  in  abortion.  After  their  use, 
and  twenty-four  hours'  plugging  of  the  os,  mat- 
ters were  found  in  a  satisfactory  condition. 


EVENING  SESSION. 

At  the  opening  of  the   evening  session,  the 
President  delivered  the  Annual  Address. 


SURGICAL  SECTION. 
Dr.     Grant,    of    Ottawa,     Chairman. 
Ross,  jr.,  of  Toronto,  Secretary. 


Dr. 


SPASMODIC    TORTICOLLIS. 

Dr.  Roddick,  of  Montreal,  exhibited  a 
patient  who  had  suffered  for  many  months 
with  a  very  painful  spasmodic  contraction  of 
the  muscles  of  one  side  of  the  neck.  The  man 
was  obliged  to  hold  his  head  in  his  hands  if  he 
wished  to  keep  it  steady,  and  this  was  only 
temporary.  Electricity  and  many  other  reme- 
dies were  tried  in  vain,  and  Dr.  Roddick 
divided  some  of  the  muscles  subcutaneously 
with  but  little  benefit.  The  actual  cautery 
was  applied  on  several  occasions  to  the  back  of 
the  neck  with  the  most  satisfactory  result. 
The  man  recovered  completely. 

REST  AND  TRACHEOTOMY. 

Dr.  Major,  of  Montreal,  advocated  rest  in 
all  diseases  of  the  throat,  and  rather  denied 
the  harm  sometimes  attributed  to  over-rest, 
claiming  that  (unless  under  tracheotomy)  per- 
fect rest  was  not  attainable  in  the  larynx,  as 
the  function  of  respiration  had  to  be  carried  on 
even  if  that  of  phonation  were  suppressed. 

Dr.  Ryerson  entirely  agreed  with  Dr.  Major 
in  regard  to  the  value  of  rest  in  laryngeal 
troubles. 

Dr.  Eisberg,  of  New  York,  said  he  held  that 
it  was  the  duty  of  those  who  devoted  them- 


OF  MEDICAL  SCIENCE. 


341 


selves  to  special  subjects  to  give  the  results  of 
their  special  knowledge  to  their  brother  prac- 
titioners. He  had  some  years  ago  had  his 
attention  drawn  to  the  fact  that  the  principle 
of  rest  in  cases  of  inflammation  applied  to  the 
throat  as  well  as  to  any  other  part  of  the  body. 
Under  the  influence  of  rest  inflammatory  con- 
ditions subsided,  and,  perhaps,  gave  way  to 
renewed  action.  The  larynx  was  moved  in 
three  functions,  namely,  in  the  produclion  of 
voice,  in  breathing,  and  in  swallowing.  The 
first  was  a  voluntary  action,  and  it  was  possible, 
therefore,  to  secure  complete  rest.  Breathing 
though  absolutely  necessary  for  life,  might  be 
made  easier,  and  by  tracheotomy  the  larynx 
might  be  relieved  from  active  participation  in 
respiration.  "Was  it  advisable  to  practise 
tracheotomy  for  this  purpose  ?  He  did  not 
share  in  the  opinion  that  it  was  a  simple  or 
harmless  operation,  but  he  considered  it  was 
valuable  in  appropriate  cases.  With  regard  to 
the  third  function,  swallowing,  tracheotomy 
did  not  afibrd  complete  rest,  but  other  means 
might  be  taken  to  give  partial  rest. 

CERVICAL    RIBS. 

Dr.  Shepherd,  of  Montreal,  read  a  paper  on 
three  specimens  of  this  anatomical  peculiai-ity. 
Two  of  them  were  exhibited  to  the  Section. 
He  also  demonstrated  his  method  of  strapping 
"  caked  "  breast. 

ECZEMA  OF  THE  NIPPLE  AND  CANCER  OF  THE 
BREAST. 

Dr.  Grant,  of  Ottawa,  read  the  notes  of  a 
case  of  this  kind,  and  referred  to  Sir  James 
Paget's  observations,  which  had  proved  a  con- 
nection between  this  afiection  and  the  develop- 
ment of  breast  cancer. 


SECOND  DAY.— SEPTEMBER  7th. 

General  Sessions. — After  routine  business, 
the 

reports  of  COMMITTEES 

were  proceeded  with. 

Dr.  Francis  J.  Shepherd,  of  Montreal,  pre- 
sented the  report  on  Surgery.  (Published  in 
this  issue.) 

The  report  on  Therapeutics  was  read  by  Dr. 
Tye,  of  Chatham,  Ontario.      It  dealt  largely 


with  the  use  of  electricity  in  various  affections, 
and  the  influence  of  different  kinds  of  currents. 
In  referring  to  the  large  number  of  new  phar- 
maceutical preparations  which  had  been  intro- 
duced, he  thought  the  majority  of  them  were 
more  beneficial  to  the  manfacturer  than  to  the 
patient. 

Dr.  Canniff  presented  an  elaborate  report  of 
the  committee  appointed  at  the  Halifax  meet- 
ing to  seek  from  the  government  improved 
legislation  in  respect  to  sanitation  and  vital 
statistics.  It  was  arranged  that  the  committee 
should  meet  and  draw  up  resolutions  to  be 
communicated  to  the  Premier. 

The  meeting  then  resolved  itself  into 
Sections. 


MEDICAL  SECTION. 

A  PECULIAR  FORM  OF  FEVER. 

Dr.  Harrison,  of  Selkirk,  Ont.,  read  a  paper 
descriptive  of  four  unusual  cases  which  pre- 
sented the  following  features :  The  disease 
came  on  insidiously,  as  a  remittent  fever,  with 
slight  tenderness  of  the  bowels,  hemorrhage 
from  the  nose,  pain  in  the  head  and  back  of 
the  neck ;  changed  to  intermittent  of  the 
quotidian  or  tertian  type ;  was  entirely  beyond 
the  influence  of  quinia,  was  complicated  with 
strabismus,  arching  of  the  neck,  painful  con- 
traction of  the  muscles  in  various  parts  so  as 
to  cause  screaming  or  sudden  piercing  shrieks  ; 
ran  a  course  of  from  four  to  fourteen  weeks, 
two  of  the  patients  dying,  one  in  the  thirteenth 
the  other  in  the  tenth  week.     No  autopsy. 

In  the  discussion  which  followed,  most  of 
the  speakers  regarded  it  as  a  form  of  cerebro- 
spinal fever.  Drs.  Holmes  and  Tye,  of  Chat- 
ham, referred  to  similar  cases. 

diphtheria. 

Dr.  Mullin,  of  Hamilton,  Ont.,  reported  two 
cases  of  diphtheria — one  of  diphtheritic  croup, 
in  which  tracheotomy  was  followed  by  a  suc- 
cessful result ;  in  the  other  the  membrane 
appeared  on  the  left  tonsil  and  uvula,  and  the 
case  ended  fatally  through  septicaemia.  He 
referred  to  considerations  showing  that  it  was 
a  constitutional  disease,  and  that  local  applicji 
tions  could  not  remove  it. 


342 


CANADIAN  JOURNAL 


CHOLERA  INFANTUM. 

Dr.  Holmes,  of  Chatham,  Ont.,  read  a  paper 
on  cholera  infantum,  from  which  the  following 
conclusions  were  deduced  :  1.  Secure  for  every 
child  proper  sanitary  conditions,  2.  Only 
resort  to  artificial  feeding  when  no  other  course 
can  be  adopted.  3.  When  obliged  to  feed  a 
child  artificially,  regulate  in  the  strictest  man- 
ner the  quantity  and  quality  of  the  food,  and 
persist  in  none  that  experience  shows  to  dis- 
agree. 4.  Maintain  the  child's  temperature  at 
or  near  the  normal,  by  means  of  cold  sponging. 
6.  Avoid  astringents  and  opiates.  6.  Rely 
upon  laxatives  combined  with  very  minute 
doses  of  hydrargyrum,  frequently  repeated. 
The  importance  of  carrying  out  the  fourth  in- 
dication was  considered  very  great. 

NEBVE-STEETCHINO  IN  SCIATICA. 

Dr.  Stewart,  of  Brucefield,  Ont.,  read  the 
reports  of  three  cases  of  sciatica  and  one  of 
painful- stump  treated  by  stretching  the  sciatic 
nerve.  One  case  of  sciatica  was  cured  and  the 
remaining  two  greatly  relieved.  The  result  in 
the  case  of  painful  stump  is  also  very  satisfac- 
tory. It  was  shown  by  tracings  taken  during 
the  stretchings  that  ether  has  little  or  no  efiect 
while  chloroform  has  a  marked  influence  in 
reducing  the  blood-pressure  and  rate  of  the 
pulse. 

TUMOUR  OF  FRONTAL  BONE  COMPRESSING  THE 
BRAIN. 

Dr.  Prevost,  of  Ottawa,  reported  the  case  of 
a  man,  aged  48,  with  a  tumor  projecting  from 
the  frontal  bone  on  right  side.  It  had  pro- 
duced exophthalmos,  but  very  little  cerebral 
disturbance.  Coma  and  death  ultimately 
supervened.  The  tumour  had  pushed  back  the 
dura  mater  and  compressed  the  frontal  lobe  to 
a  considerable  extent. 

Dr.  Cameron,  of  Toronto,  exhibited  a  boy 
with 

PSEUDO  HYPERTROPHIC  MUSCULAR  PARALYSIS, 

and  commented  upon  the  general  features  of 
the  disease.  He  called  special  attention  to  the 
mode  of  arising  from  a  kneeling  or  recumbent 
posture,  which  was  very  well  exemplified  in 
his  patient. 


Dr.  Temj)le,  of  Toronto,  mentioned  a  case  of 
this  disease  occurring  in  a  man  aged  64. 

ECHINOCOCCUS    OF   LIVER,  BURSTING    INTO    LUNG. 

Dr.  Black,  of  Uxbridge,  read  the  notes  of 
the  case.  The  patient,  a  clergyman,  had  had 
an  hepatic  tumour  for  over  four  years.  It  had 
been  tapped,  and  the  diagnosis  of  a  hydatid 
cyst  made.  Latterly  septic  symptoms  buper- 
vened,  and  the  spleen  became  greatly  enlarge  d 
Dea^h  was  caused  by  bursting  of  the  cyst  into 
the  lung,  with  the  discharge  of  a  quantity  of 
pus.  A  large  suppurating  hydatid  cyst  was 
found  in  the  liver ;  it  had  burst  through  the 
diaphragm.  A  huge  single  cyst  existed  in  the 
spleen. 

PHANTOM  PREGNANCY. 

Dr.  H.  p.  Wright,  of  Ottawa,  reported  the 
case  of  a  middle-aged  woman  who  had  borne 
two  children  ;  believed  herself  to  be  pregnant ; 
thought  she  had  quickened  ;  and  a  month  after 
the  time  she  expected  to  be  confined,  presented 
an  abdominal  tumor  and  peculiar  movements 
which  simulated  somewhat  those  of  a  child. 
It  was  thought  at  first  that  there  might  be  an 
ovarian  tumor ;  but  on  putting  the  patient 
under  ether,  the  true  nature  of  the  case  became 
evident. 

CHEMICAL     COMPOSITION    OF    THE     MILK    OP     DI8- 
TILLKRY-FED  COWS. 

Dr.  Ellis,  of  the  School  of  Practical  Science, 
Toronto,  together  with  Prof.  Croft,  had  ex- 
amined the  milk  of  sixteen  cows — eight  of 
which  were  fed  on  distillery  refuse  and  hay, 
and  eight  upon  other  kinds  of  food.  No  dis- 
tinction could  be  made  between  the  two  classes 
of  milk  by  microscoi)ical  observation,  and  no 
difference  was  observed  as  to  keeping  qualities. 
The  specific  gravity  of  the  milk  of  the  distillery- 
fed  cows  averged  1,029,  and  in  one  case  fell  as 
low  as  1,025.  The  specific  gravity  of  the  milk 
of  the  other  cows  averaged  1,032.  In  the 
milk  from  distillery-fed  cows,  the  total  solids 
averaged  14.64  per  cent.,  and  reached  in  one 
case  17.96  per  cent.  In  the  other  milk  the 
average  was  12.82  per  cent.  The  excess  of 
solids  in  the  distillery-fed  cows  is  owing  to  an 
increased  quantity  of  fat,  vphich  averaged  5.50 
jjer  cent,  in  the  distillery-fed  cows,  and  reached 


OF  MEDICAL  SCIENCE. 


343 


in  one  case  8.49  per  cent.     In  the  other  cases 
the  fat  averaged  3.27  per  cent. 


SURGICAL  SECTION. 

The  Section  met  at  3  p.m.,  Dr.  Grant  in  the 
chair. 

OBSTRUOTION    IN   THK    AIR  PASSAGES. 

Dr.  HiNGSTON,  of  Montreal,  related  cases 
illustrating  the  eflPects  of  foreign  bodies  in  the 
trachea  and  bronchi,  the  two  most  remark- 
able instances,  being  false  tooth  in  the  windpipe 
for  over  three  months,  and  a  pin  in  the  trachea 
for  eleven  months. 

POLYPOID    FIBROMA    OF    THE    BLADDER. 

Dr.  Fulton,  of  Toronto,  described  the  case, 
which  occurred  in  a  child  one  year  and  eight 
months  old.  Symptoms  of  stone  were  present, 
but  nothing  was  discovered  with  the  sound. 
Pus  occurred  in  the  urine.  The  child  died 
suddenly  from  rupture  of  the  bladder.  The 
specimen  was  shown  to  the  Section. 

POLYPUS   NASI. 

Dr.  Ryerson,  of  Toronto,  strongly  urged  the 
use  of  glacial  acetic  acid  in  these  tumours,  and 
preferred  the  snare  to  the  forceps. 

MODERN   LITHOTRITY, 

Dr.  Walker,  of  Detroit,  gave  an  account  of 
several  cases,  with  a  summary  of  the  advan- 
tages of  this  method  of  operation. 

NEW   OPERATION    FOB    HARELIP. 

Dr.  Good  Willie,  of  New  York,  showed  an 
instrument  for  keeping  the  parts  together,  and 
advised  the  operation  immediately  after  birth. 

AFFECTIONS    OP  THE    ORBIT   AND    FRONTAL 
SINUS. 

Dr.  R.  A.  Reeve  read  a  paper  on  "  Orbital 
Diseases,"  giving  the  features  of  some  orbital 
affections,  and,  in  view  of  the  uncertainty 
often  felt  as  to  their  nature,  alluding  to  the 
utility  of  exploratory  incisions  as  an  aid  to 
diagnosis.  Malignant  disease  may  start  in  the 
orbit  proper,  and  it  should,  of  course,  be 
attacked  without  delay,  but  it  not  infrequently 
spreads  to  the  orbital  tissues  from  the  eyeball, 
lids,  (fee,  as  in  the  case  of  glioma,  sarcoma,  and 


epithelioma.  The  importance  of  an  early  cor- 
rect diagnosis  and  of  timely  removal  of  the  eye 
or  other  diseased  parts  was  urged,  albeit  in 
some  cases  of  long  standing  and  far  advanced 
the  removal  of  the  contents  of  the  socket  with 
the  use  of  zinc  chloride,  <kc.,  or  again  of  the 
lids  and  other  superficial  parts  had  proved 
effectual.  In  the  latter  instance  a  plastic 
operation  could  be  conjoined  or  be  done  later, 
in  order  to  relieve  deformity.  Specimens  of 
tumors  and  photographs  of  cases  were  shown. 

EXCISION    OF    THE    KNEE. 

Dr.  Fenwick,  of  Montreal,  showed  a  series 
of  photographs  and  specimens,  illustrating  his 
last  series  of  excision  cases.  Of  twenty -six 
excisions  of  the  knee  in  the  Montreal  General 
Hospital,  two  had  died,  and  in  two  cases  sub- 
sequent operation  was  required.  One  of  the 
deaths  was  due  directly  to  heart  disease. 

Dr.  Cameron,  of  Toronto,  presented  a  patient 
who  had  sustained  a  fracture  of  the  ischium 
and  sciatic  dislocation  last  February.  Reduc- 
tion of  the  dislocation  could  not  be  maintained, 
yet  the  man  was  able  to  get  about  fairly  well, 
and  had  returned  to  work ;  also  an  ununited 
fracture  of  femur,  patient  being  able  to  walk 
with  a  leather  support ;  also  an  immense  recu- 
rent  tumo.  of  the  face,  in  which  for  the  prim- 
aiy  disease  the  right  upper  jaw  had  been 
removed  five  years  ago  followed  by  a  quisecent 
period  of  three  years.  General  health  still 
unaffected. 

ECZEMA   TREATED    WITH    VIOLA    TRICOLOR,    OR 
WILD    PANSY. 

Dr.  Ferguson  reported  three  cases  success- 
folly  treated  by  the  internal  administration  of 
this  drug. 

A  paper  by  Dr.  Mills,  of  Montreal,  on 

"MISTAKES    TO    BE    AVOIDED    IN    TREATMENT     OF 
AFFECTIONS    OF    THE    NOSE    AND    THROAT," 

was  taken  as  read. 


THIRD  DAY.— SEPTEMBER  Sth. 

After  routine  business  Dr.    Worthington,  of 
Clinton,  Ontario,  read  a  paper  on 

CLIMATOLOGY, 

dealing  chiefly  with  the  subject  of  malaria  in 


344 


CANADIAN  JOURNAL 


the  Ontario  {leninsula.  In  the  portion  of  the 
Province  bordering  ujion  Lake  Erie,  the  St. 
Clair  district,  and  the  southern  end  of  Lake 
Huron,  malaria  still  abounds,  but  the  general 
opinion,  obtained  in  answer  to  certain  queries, 
is  that  it  has  lessened  with  the  increased  culti- 
vation and  better  drainage.  The  poison  seems 
more  active  after  July,  and  a  long  dry  period 
after  a  wet  one  renders  it  particularly  preva- 
lent. 

It  was  suggested  that,  in  addition  to  more 
thorough  drainage  and  the  removal  of  superflu- 
ous dams  in  the  streams,  the  eucalyptus  tree 
might  be  planted  in  certain  districts. 

In  the  discussion  which  followed,  Dr.  Mc- 
Donald, of  Hamilton,  referred  to  the  general 
decrease  of  the  disease  with  the  better  cultiva- 
tion of  the  land.  It  had  occurred  every  year 
in  Hamilton  for  the  past  thirty  years. 

Dr.  Osier  referred  to  the  increase  of  the 
affection  in  certain  districts  which  had  been 
hitherto  almost  free  from  it,  or  in  which  it  had 
not  been  seen  for  some  years.  He  believed  it 
was  spretding  in  the  New  England  States  and 
in  parts  of  New  York,  about  Montreal,  and  in 
this  city,  where  malaria  is  almost  unknown, 
cases  originating  in  the  district  had  become 
more  frequent. 

The  report  of  the  Special  Committee  on 
Sanitation  and  Vital  Statistics,  was  then  read 
by  Dr.  Canniflf. 

The  following  resolutions  were  adopted  : 

1.  That  for  the  present  the  sanitary  statis- 
tics shall  be  confined  to  the  cities  and  larger 
towns  of  the  Dominion,  such  to  be  published 
monthly,  and  the  deductions  therefrom  to  be 
circulated  in  the  various  centres  specified. 
2.  That  for  future  guidance  in  sanitary  matters 
a  commission  should  be  appointed  by  the  Do- 
minion Government,  in  order,  in  consultation 
and  co-operation  with  the  various  Local  Gov- 
ernments, to  arrive  at  some  common  basis  of 
action  in  carrying  out  such  sanitary  measures 
as  may  be  necessary  for  the  guidance  of  the 
Dominion  Government.  3.  That  such  com- 
mission shall  consist  of  at  least  two  or  more 
medical  men  with  a  legal  adviser,  whose  duty 
it  shall  be  to  examine  carefully  into  the  various 
requirements  of  such  action  in  sanitary  mat- 
ters. 


The  Nominating  Committee  reported  the 
following 

OFFICERS    FOR   THE    ENSUING    YEAR: 

President — Dr.  Mullen,  of  Hamilton. 

Vice-Presidents — for  Ontario,  Dr.  Tye,  of 
Chatham  ;  for  Quebec,  Dr.  Gibson,  of  Cowans- 
ville  ;  for  New  Brunswick,  Dr.  Atherton,  of 
Fredericton  ;  for  Nova  Saotia,  Dr.  Jennings, 
of  Halifax ;  tor  Manitoba.  Dr.  Kerr,  of  Win- 
nipeg. 

General  Secretary — Dr.  Osier,   of  Montreal. 

Treasurer — Dr.  Robillard,  of  Montreal. 

Local  Secretaries — for  Ontario,  Dr.  Saun- 
ders, of  Kingston ;  for  Quebec,  Dr.  Brunelle, 
of  Montreal;  for  New  Brunswisk,  Dr.  Cole- 
man; for  Nova  Scotia,  Dr.  Almon,  jr.;  for 
Manitoba,  Dr.  Whiteford. 

The  report  was  adopted  and  the  nominees 
were  duly  elected.     In  the 

MUSEUM 

Dr.  Sutherland  exhibited  a  series  of  twelve 
specimens  illustrating  some  of  the  Modes  of 
Termination  of  Aneurism. 

Dr.  Osier  exhibited  slides  of  the  Bacillus  of 
Anthrax,  and  the  Bacillus  of  Tuberculosis. 

Dr.  Graham  exhibited  slides  of  Koch's 
Tubercle  Bacillus  and  Ponfick's  Actinomycosis. 

After  the  usual  vote  of  thanks,  etc.,  the 
meeting  adjourned  at  12.30. 

The  next  place  of  meeting  is  fixed  for  King- 
ston, Ontaiio,  on  the  first  "Wednesday  of  Sep- 
tember, 1883. 


SANITARY  CONVENTION  AT  ST. 
THOMAS. 

The  Convention  opened  September  19th. 
Mayor  Van  Buskirk  in  the  chair. 

Mayor  Van  Buskirk,  M.D.,  delivered  an 
address  of  welcome  on  behalf  of  the  citizens 
of  St.  Thomas.  He  then  referred  to  the  im- 
mense field  covered  by  sanitary  measures,  and 
felt  convinced  that  it  could  not  be  gone  over 
at  a  single  convention.  He  recognized  the 
wisdom  of  the  Legislature  in  creating  the 
Provincial  Board  of  Health  and  dilated  on  tlie 
importance  of  the  work  undertaken  by  it. 
Letters  of  regret  at  inability  to  attend  were 
read  by  the  Secretary,  from  Dr.  Bray,  Presi- 
dent of  College  of  Physicians  and   Surgeons, 


OF  MEDICAL  SCIENCE. 


345 


Ontario,  Dr.  Harris,  Secietary  of  State  Board 
of  Health,  N.Y. ;  Dr.  Baker,  Secretary  of  State 
Board  of  Health,  Michigan ;  Dr.  White,  Chief 
Officer  of  Health,  Detroit ;  and  Dr.  Edwards, 
London,  The  President's  Inaugural  address 
was  postponed  till  the  evening.  Judge  Hughes, 
of  St.  Thomas,  then  read  an  excellent  and  in- 
structive paper  on  food  adulteration  which 
elicited  considerable  discussion  in  which  Drs. 
Oldright,  W.  H.  Ellis,  Yeomans,  Wilson, 
M.P.,  Mr.  Emerson  Coatsworth,  and  others, 
participated,  and  the  following  resolution  was 
passed  :  "  That  the  Chairman  appoint  a  com- 
mittee to  consider  and  report  on  desirable 
amendments  to  the  Inspection  of  Food  Act, 
with  a  view  to  secure  prompt  inspection  and 
analysis  of  suspected  commodities  at  the  in- 
stance of  private  consumers.  Drs.  Yeomans, 
McLarty,  Coyne,  and  Messrs.  Farley  and 
Casey  were  named.  Drs.  Oldright,  McLarty, 
and  Luton,  were  nominated  a  Committee  to 
inspect  and  report  on  Sanitary  Apparatus.  In 
the  evening  a  letter  was  read  from  Prof.  W. 
B.  Carpenter,  C.B.,  M.D.,  regretting  his  in- 
ability to  be  present,  and  making  some  valu- 
able suggestions  in  reference  to  sanitary 
matters. 

Dr.  Oldright  then  delivered  the  Inaugural 
Address,  in  which  he  dealt  broadly  with  var- 
ious topics  of  Sanitary  Science  and  Practice 
and  enforced  the  value,  particular  and  general, 
of  Sanitary  Conventions.  Dr.  W.  H,  Ellis, 
then  read  a  valuable  paper  on  the  Impurities 
of  Water,  which  elicited  much  general  discus- 
sion, and  judging  by  the  number  of  questions 
the  Doctor  was  called  upon  to  answer,  must 
have  been  a  source  of  interest  and  instruction 
to  many.  Dr,  R,  W,  Bruce  Smith,  of  Sparta, 
and  the  Rev,  Prof.  Austin,  of  Alma  College, 
St.  Thomas,  then  followed  with  two  valuable 
papers,  the  former  on  the  subject  of  Contagion, 
and  the  latter  on  that  of  Public  Schools  and 
Health,  after  the  discussion  of  which  the  meet- 
ing adjourned. 

September,  20th. 

The  committee  appointed  to  examine  sani- 
tary apparatus  reported.  They  had  examined 
the  earth  closets  of  the  Earth  Closet  Company, 
13  Jarvis  Street,  Toronto,  and  of  John  Cameron, 
No.   1   Victoria  Street,  and   were  very  much 


pleased  with  them.  Their  great  advantage 
was  their  automatic  action,  which  was  very 
good  and  not  liable  to  get  out  of  order.  They 
recommended  the  substitution  of  the  dry  earth 
system  instead  of  the  use  of  privy  pits  and 
cesspools,  now  so  common.  The  committee  had 
also  examined  the  diagram  of  a  patent  trap, 
styled  an  "air  syphon  trap,"  by  Mr.  J.  Caldwell, 
of  Edinburgh,  Scotland,  and  staying  at  75  Rich- 
mond Street,  Toronto.  On  this  they  expressed 
a  qualified  opinion.     The  report  was  adopted. 

Registrar  McLaohlan,  of  St.  Thomas,  in  sup- 
porting it,  made  some  remarks  as  to  the  adop- 
tion by  municipalities  of  the  earth-closet  system. 

Dr.  J.  Coventry,  of  Windsor,  read  a  paper 
on  the  prevention  of  small-pox.  He  said  that 
the  following  diseases  were,  to  a  large  extent, 
preventable,  viz.,  cholera,  yellow  fever,  typhoid 
and  scarlet  fever,  small-pox,  diphtheria,  measles, 
and  whooping-cough.  These  diseases  might  all 
be  circumvented  by  isolation  and  disinfection. 
He  gave  an  account  of  the  restriction  of  scarlet 
fever  in  Windsor  daring  the  present  year.  The 
physicians  were  required  to  report  all  cases 
within  twenty-four  hours  after  discovery.  The 
house  was  at  once  placarded  with  the  name  of 
the  disease,  and  where  possible  one  large  room 
was  selected  as  a  hospital,  and  carpets,  window 
hangings,  and  upholstered  furniture  removed. 
The  members  of  the  family  attacked  were  taken 
to  this  room  and  kept  there  until  all  shedding 
of  the  skin  had  taken  place.  No  members  of 
the  family  were  allowed  to  leave  the  premises 
except  those  who  did  not  come  in  contact  with 
the  infected  members.  After  recovery  and  ex- 
foliation strong  sulphurovis  soap  was  used  to 
wash  with,  and  all  clothing  was  thoroughly  dis- 
infected by  means  of  sulphurous  acid  gas.  No 
public  funeral  was  permitted ;  interment  was 
urged  without  delay,  and  the  hearse  and  car- 
riages were  at  once  disinfected.  During  part 
of  the  epidemic  the  schools  were  closed.  The 
citizens  lent  all  their  aid  to  co-operate  with  the 
board.  Small-pox  made  its  appearance  in  the 
same  town  last  April,  and  similar  measures 
were  adopted,  with  the  a  Idition  of  vaccination. 
None  but  citizens  had  power  to  pass  compulsory 
vaccination  laws.  This  power,  under  the  ap- 
proval of  the  Board  of  Health,  should  un- 
doubtedly be  extended  to  other  municipalities. 


346 


CANADIAN  JOURNAL 


He  alHO  advocattiU  utrict  quarantine  on  all  the 
borders  of  the  country.  Children  should  be 
taught  the  rules  of  hygiene  at  school.  In  some 
subsequent  i-emarks  he  said .  that  out  of  forty 
persons  attacked  with  amall-pox,  in  Windsor, 
ten  were  not  vaccinated,  and  eight  of  these 
died.  The  remaining  thiity  were  vaccinated, 
and  none  of  them  died. 

Dr.  Kains  would  like  to  hear  some  expres- 
sion as  to  the  working  of  the  Act  creating  the 
Board  of  Health,  and  whether  the  provisions 
for  the  isolation  of  disease  and  placarding 
houses  were  practicable. 

Dr.  Oldright  said  the  placarding  of  houses 
had  most  beneficial  results.  As  to  the  objec- 
tion that  it  would  have  a  bad  effect  on  the 
place,  he  would  much  sooner  live  in  a  town 
where  houses  were  placarded  and  sanitary 
measures  adopted  than  where  they  tried  to 
cover  such  things  up.  Referring  to  but  one 
disaster,  he  felt  safe  in  saying  that  by  proj)er 
sanitary  measures  they  would  prevent  the 
equivalent  of  a  Victoria  disaster  every  year. 
The  board  had  only  advisory  powers,  and  they 
recommended  the  isolation  of  scarlet  fever 
patients,  and  other  means  of  prevention.  He 
related  a  case  of  death  resulting  from  getting  a 
cloak  made  at  a  house  where  there  was  scarlet 
fever.  Toronto  was  following  the  example  of 
Windsor,  but  had  not  yet  got  to  the  point  of 
compulsory  isolation  and  the  placarding  of 
houses.  One  objection  was  that  it  would  inter- 
fere with  business.  Even  if  they  considered 
the  matter  from  a  pecuniary  point  of  view,  the 
disease  was  worse  when  covered  up  than  when 
the  house  was  placarded.  He  read  some 
scathing  remarks  by  Dr.  White  as  to  placard- 
ing being  a  violation  of  personal  liberty,  and 
denounced  as  absurd  the  doctrine  that  placard- 
ing was  a  breach  of  the  confidence  reposed  in 
a  physician.  It  was  due  to  Dr.  Coventry  and 
his  fellow- workers  in  Windsor  that  small-pox 
had  not  spread  through  this  portion  of  the 
province. 

A  vote  of  thanks  was  passed  to  Dr.  Coven, 
try  for  his  valuable  paper. 

Mr.  Colin  McDougall,  of  St.  Thomas,  thought 
the  convention  should  give  an  expression  of 
opinion  on  the  subject. 


UieilTHKUIA  AND  SCARLSr  F£V£U. 

Dr.  p.  H.  Bryce  spoke  especially  on  the 
subject  of  diphtheria  and  scarlet  fever.  These 
were  not  apparently  so  dangerous  as  smallpox, 
but  really  created  much  more  havoc.  Measles 
also  caused  much  mortality,  as  there  was  but 
slight  attention  paid  to  the  disease.  In  many 
of  these  afflictiojjs  it  was  very  difficult  to  know 
the  nature  of  the  disease  for  the  first  twenty- 
four  hours,  and  that  time  was  sufficient  to  com- 
municate the  infection  to  others  ;  and  parents 
should  at  once  api)ly  to  their  family  physician 
in  order  to  have  the  disease  properly  diagnosed. 
It  was  just  because  these  diseases  did  not 
appear  dangerous  that  their  total  mortality 
was  so  large.  He  had  last  year  the  oppor- 
tunity of  seeing  a  great  deal  of  diphtheria  in 
Guelph.  The  sanitary  provisions  were  bad, 
and  the  mortality  Very  great,  probably  a  hun- 
dred deaths.  He  considered  the  chief  reason 
of  this  was  the  slight  attention  paid  to  these 
diseases. 

The  following  resolution,  moved  by  Mr. 
Colin  McDougall,  and  seconded  by  Dr.  Bryce, 
was  carried  : — 

"  That  this  Convention  has  heard  with  much 
pleasure  Dr.  Coventry's  account  of  the  success 
which  has  attended  the  adoption  in  the  town 
of  Windsor  of  measures  for  arresting  the 
spread  of  scarlet  fever,  diphtheria,  and  other 
contagious  diseases,  and  would  urge  upon  other 
municipalities  the  adoption  of  similar  measures* 
such,  for  instance,  as  the  prompt  isolation  in 
their  own  houses  or  in  hospitals  of  the  first  and 
all  cases  of  these  diseases,  which  at  present 
make  such  havoc  among  our  people." 

Dr.  W.  C.  Van  Buskirk,  of  St.  Thomas,  read 
a  paper  on  sewerage  as  a  sanitary  measure.  He 
said  that  there  were  three  modes  of  disposing 
of  sewage.  The  first  was  the  old  method  now 
in  uwe  in  St.  Thomas,  namely,  the  cesspool,  re- 
ceiving all  the  filth  from  a  house  and  acting  like 
a  fermenting  tun  in  a  brewery,  constantly  in 
action  from  fresh  accessions,  and  giving  rise  to 
noisome  effluvia  (ammonia,  sulphuretted  hydro- 
gen, and  carbonic  acid),  thus  poisoning  the 
atmosphere,  while  owing  to  the  imperfect  con- 
dition of  the  walls  the  excreta  pass  through  the 
porous  and  stratified  earth  into  the  neighbour- 
ing wella       The  first   indication  of  vitiating 


OF  MEDICAL  SCIENCE. 


347 


matter  appeared  when  the  water  had  been 
drawn  for  some  time.  It  then  became  turbid, 
and  they  might  be  sure  it  contained  sewage. 
On  an  examination  of  it  with  a  microscope  they 
would  find  bacteria  and  infusoria,  the  frequent 
cause  of  bowel  complaint,  typhoid,  and  kindred 
zymotic  diseases.  Bearing  on  the  same  subject 
■was  the  fact  lately  noticed  by  Davaine  that  the 
splenic  apoplexy  of  sheep  is  owing  to  the  pres- 
ence of  bacteria  in  the  blood,  and  that  sheep, 
rabbits,  and  horses  can  be  inoculated  by  trans- 
ferring into  their  circulation  the  bacteria, which 
are  exceedingly  thin  and  rod-like,  varying  in 
length  from  one  two-thousandth  to  one  six- 
thousandth  of  an  inch.  The  same  observer  had 
first  found  bacteria  are  present  in  all  carbunclar 
diseases  of  whatever  form  ;  and  the  superven- 
tion of  these  little  beings  in  the  spleen,  lungs, 
and  blood  precedes  the  occurrence  of  morbid 
phenomena,  and  that  the  carbuncular  blood 
ceases  to  be  contagious  as  soon  as  the  bacteria 
have  disappeared.  Hence  Davaine  felt  justified 
in  regarding  them  as  the  cause  of  carbuncle.  If 
one  contagious  disease  could  be  proved  to  be 
connected  with  the  germs,  it  was  almost  cer- 
tain that  similar  diseases  must  arise  from  cor- 
responding causes.  The  second  method,  dry 
eai-th  closets,  was  the  best  for  suburban  parts  of 
a  city  where  the  expense  of  constructing  sewers 
and  conveying  water  for  the  purpose  of  flushing 
would  be  too  great,  and  where  slops  and  dish- 
water may  be  disposed  of  in  compost  heaps  or 
on  the  surface  of  the  earth,  dry  earth  or  ashes 
being  sprinkled  over  them  from  time  to  time. 
The  dry-earth  system  only  enabled  part  of  the 
sewage  to  be  removed.  Dish-water  contained 
gravy,  bits  of  meat,  (fee,  which,  when  thrown 
out,  underwent  putrefactive  fermentation,  and 
gave  rise  to  unwholesome  smells.  The  system, 
therefore,  was  clearly  not  adapted  to  thickly 
settled  districts.  The  plan  recommended  by 
Col.  Waring,  in  use  at  Memphis,  was  by  some 
considered  the  most  preferable.  It  was  a  small 
sewer  or  pipe  drain  laid  on  each  side  of  the 
street,  having  no  openings  into  the  streets  for 
ventilation.  Consequently,  should  fermenta- 
take  place  there,  the  foul  gusts  would  be  more 
apt  to  force  open  the  water  seals  in  the  houses 
than  if  there  were  openings  in  the  streets.  They 
were  also  objectionable  because  of  the  expense 


of  laying  two  separate  drains.  There  were 
many  persons  in  St.  Thomas  under  the  erron- 
eous impression  that  sewers  by  producing  gases 
do  more  harm  than  good.  In  the  early  days 
sewers  were  built  very  large,  as  it  was  deemed 
necessary  that  they  should  be  entered  and 
cleaned  out,  and  these  are  still  to  be  found  in 
many  places  where  the  flat  nature  of  the 
country  gave  them  the  character  of  a  prolonged 
cesspool.  But  where  a  fall  of  one  foct  in  three 
hundred,  or  even  one  in  five  hundred,  could  be 
obtained,  and  where  the  small  sewer  is  adopted, 
that  is  one  sufficiently  large  to  convey  the  rain 
fall,  house  sewage,  and  land  drainage,  with  flush 
tanks  at  the  head  of  each  to  wash  every  particle 
once  in  twenty-four  hours,  fermentation,  and 
consequently  the  formation  of  gas,  was  pre- 
vented. Ventilating  tubes  fixed  to  the 
soil  pipes  outside  of  buildings  would  prevent 
any  pressure  on  the  water  seal, and  would  freely 
ventilate  the  sewer. 

The  reading  of  this  paper  gave  rise  to  a 
long  discussion  on  the  question  of  sewage, 
particularly  with  regard  to  the  drainage  of  St. 
Thomas.  Drs.  Coventry,  Oldright,  Bryce, 
VanBuskirk,  Registrar  McLachlan,  Aid.  Hunt, 
and  others  took  part. 

A  vote  of  thanks  was  passed  to  the  chair- 
man for  his  paper. 

Dr.  Cassidy,  of  Toronto,  read  a  paper  on 
the  heating  and  ventilation  of  buildings.  Dur- 
ing the  summer  months  ventilation  was  obliga. 
tory,  and  was  efficiently  carried  out,  but  dur- 
ing winter  it  was  difficult  to  combine  heating 
and  ventilation  without  the  expense  consequent 
on  the  free  consumption  of  fuel.  Yet  much 
might  be  done  at  small  cost  by  an  intelligent 
application  of  certain  methods.  In  the  first 
place,  the  house  must  be  perfectly  clean  ;  in 
the  second  place,  every  room  should  be  furnished 
with  a  fire-place,  grate,  or  open  flue  commun- 
icating with  the  heated  chimney.  These  flues 
should  be  made  to  open  at  the  base  line  of  the 
room,  and  communicate  directly  with  the  open 
air.  Thirdly,  a  sufficient  supply  of  pure, 
warm  air  should  be  distributed  to  the.  various 
living  rooms.  The  speaker  then  showed  a 
diagram  of  this  heating  plan  of  ventilating  a 
room  heated  by  a  coal  stove.  Ventilation  v/slq 
obtained  by    a  four-inch    globe  opened  at    the 


48 


CANADIAN  JOURNAL 


bottODi,  taking  air  ti-oui  the  floor,  and  connect- 
ing with  the  chimney.     By  means  of  this  pipe 
the  heated  chimney  carries  foul  air  out  of  dooi*8. 
Where  heating  by  hot  air  was  adopted  it  was 
necessary  that  the  inlet  and  delivery  of  pipes 
be  kept  clean,  and  it  would  be  well  to  have  a 
fine   wire   screen   over    the   outer   and    inner 
orifices  of  the  inlet  pipe.     In  large  buildings 
heated  by  steam  or  hot  water  the  same  prin- 
ciple of  efficient  supply  and  exhaust  must  be 
observed.      He    explained   tlie   old   and    new 
methods   of  ventilation   used   in   the   Detroit 
House  of  Correction,  the  latter  and  preferable 
being  by  extending  ventilating  shafts  from  be- 
hind the  several  cells  to  and  through  the  roof 
in  some  instances,  and  in  others  utilizing  old 
neglected  flues  or  shafts  to  rarefy  the  contained 
air  and   thus  induce  an   inflow  below,  and   a 
continuous    exhaustion.        This    supplies    the 
needed  exhaustion,  while  beneath  and  in  front 
of  a  large  window  on  either  side  of  said  corri- 
dor are  placed  large  bores  made  to  fit  the  win- 
dows  closely,  containing   an  abundant   steam 
coil,   and   so   arranged    that   on   opening    the 
lower  sash  of  the  window  fresh  air  is  permitted 
to  flow    down   behind   an   intervening  screen, 
and    beneath   this   steam    coil    and    hence    up 
through  said  coil,  to  be  discharged  by  a  well- 
regulated  opening  at  the  top.     After  describ- 
ing a  somewhat  similar  method  of  ventilation  [ 
in  the  Toronto  General  Hospital  in  the  older 
portion  of  the  building,  he  said  that  a  more 
efficient  system  of  exhaust  would  be   to  pro- 
vide four  flues,  each  containing  a  coil  of  steam 
pipe,   for  each   ward.      These   flues  could   be 
grouped  in  a  central  column  passing  from  flat 
to  flat,  terminating  in  screened  outlets  at  the 
roof.      The   ventilation   of  the   more   modern 
part  of  the   Toronto  hospital  is   furnished  by 
the  Reynold's  system.    The  exhaust  is  obtained 
by  a  central  shaft  passing  from  the  basement 
through  the  roof  and  terminating  in  an  orna- 
mental chimney.     This  shaft  contained  a  cen- 
tral iron  tube  used  as  a  flue  for  the  furnace  in 
the  basement,  which  heated  the  baths.     Each 
room  was  connected  with  this  shaft  by  ventil- 
ating tubes  opening   at  the   base  line   of  the 
room.     In   winter,  when  the   doors  and    win- 
dows were  closed,  the  outside  air,  collected  by 
a  large  tube,  passes  over  a  dome  in  the  base- 


ment heated  by  a  ftirnace,  whence  it  is  dis- 
tributed to  the  various  rooms  by  tubes  open- 
ing in  the  walls  about  three  or  four  feet  from 
the  ceiling.  Provision  is  made  for  lowering 
the  temperature.  This  system  is  really  admir- 
able. Whatever  method  is  adopted  all  soil 
pipes,  closets,  lavatories,  drains,  (fee,  should  be 
provided  with  independent  ventilation  by 
pipes  extending  beyond  the  roof.  Another 
question  of  importance  was  the  supj)ly  of  a 
guflicient  quantity  of  moisture  with  heat. 
Water  absorbed  impurities,  and  also  rendered 
the  heat  more  agreeable  to  the  health.  It 
might  be  evaporated  in  pans,  or  placed  in  a 
section  of  pipe  which  conducted  hot  air  from 
the  cellar  to  the  room  above.  Care  should  be 
taken  that  the  water  was  fresh  and  the  vessels 
clean.  The  proper  ventilation  of  cellars  was 
of  the  first  importance,  and  the  system  of  ven- 
tilation by  flues  already  described,  should  be 
applied  to  them.  Carbonic  acid  was  a  very 
hurtful  ingredient  of  impure  air,  but  there 
were  others  of  a  more  complex  nature  escaping 
from  the  clothing,  the  lungs,  and  the  skin. 
Fortunately  carbonic  acid  gas  was  endowed 
with  a  power  of  difiusion,  which  prevented  it 
from  exercising  its  poisonous  power.  Though 
much  heavier  than  air  it  rapidly  difi"used  itself, 
and  was  present  in  the  air  near  the  ceiling  as 
abundantly  as  near  the  floor. 

Dr.  Yeomans  said  12  per  cent,  of  the  deaths 
in  this  province  were  from  consumption — an 
essentially  in-door  disease,  and  one  which  re- 
sulted, to  a  great  extent,  from  impure  air,  and, 
therefore.  Dr.  Cassidy's  paper  was  one  of  great 
importance. 

Principal  Miller,  of  the  St.  Thomas  Col- 
legiate Institute,  said  that  the  foundation  of 
ill-health,  produced  by  breathing  impure  air, 
was  laid  in  the  Public  Schools.  The  majority 
of  the  schools  were  constructed  regardless  of 
the  question  of  ventilation.  This  was  a 
matter  to  which  public  attention  should  be 
drawn. 

Registrar  McLachlan,  of  St.  Thomas,  gave 
one.  or  two  instances  in  which  he  saw  the  prin- 
ciples enunciated  in  Dr.  Cassidy's  paper  practi- 
cally applied.  One  was  a  Church  in  George- 
town, and  it  possessed  the  additional  advantage 
of  economizing  the  fuel. 


OF  MEDICAL  SCIENCE. 


349 


A  vote  of  thanks  was  passed  to  Dr.  Cassidy 
for  his  paper. 

Votes  of  thanks  were  passed  to  the  County 
Council  for  the  use  of  the  Court  House ;  to  the 
various  Railway  Companies  for  reduced  fares ; 
to  Mayor  Van  Buskirk  for  the  able  manner  in 
which  he  had  presided  over  the  meetings ;  and 
to  the  representatives  of  the  press. 

The  Convention  then  finally  adjourned. 

The  smallness  of  the  attendance  is  attributed 
to  the  counter-attraction  of  the  fair,  but  in 
other  respects  the  Convention  was  a  most 
successful  one. 


NORTH-WESTERN  BRANCH,  ONTARIO 
MEDICAL  ASSOCIATION. 

A  meeting  of  the  above  branch  was  held  at 
Palmerston,  on  Thursday,  August  17th.  Dr. 
Stewart,  of  Brucefield,  presided.  About 
thirty  members  were  present.  After  the 
usual  preliminaries,  Dr.  Mackid,  of  Lucknow, 
showed  a  case  of  scrofulous  disease  of  the 
ankle-joint,  which  elicited  a  good  deal  of  dis- 
cussion as  to  whether  it  was  proper  to  attempt 
to  save  the  limb,  or  amputate  in  order  to  pre- 
serve the  patient's  life. 

Dr.  Yeomans,  of  Mount  Forest,  presented  a 
very  interesting,  but  rather  obscure,  case  of 
disease  of  the  spinal  cord.  The  patient  is  58 
years  of  age,  previously  healthy  ;  a  year  ago 
last  April  had  an  attack  of  pleuritis,  followed 
by  loss  of  power  in  the  upper  extremities ; 
subsequently  symptoms  of  paralysis  occurred 
in  the  lower  extremities.  He  cannot  walk 
without  crutches,  cannot  stand  or  walk  with 
his  eyes  closed.  His  powers  of  co-ordination 
are  at  fault ;  no  feeling  of  constriction ;  feels 
as  if  walking  on  a  very  rough  surface.  Patel- 
lar tendon  reflex  present,  no  pain  in  spinal 
column.  Any  smooth  article  placed  in  his 
hand  feels  as  if  it  had  a  rough  uneven  surface ; 
No  delayed  sensation.  Habits  of  life  have 
always  beep  good.  Increased  irritability  by 
electricity. 

Dr.  Stewart,  of  Palmerston,  showed  a  case 
of  infantile  paralysis,  having  two  separate 
lesions,  the  right  arm  and  left  leg  being  para- 
lyzed. Also,  a  case  of  neuramatous  tumour  of 
the  ulnar  nerve,  accompanied  by  Sfivere  pains, 


no  doubt  resulting  from  injury  at  the  same 
j  time  he  received  a  compound  fracture  of  the 
humerus. 

Dr.  Burgess  read  a  very  instructive  paper  on 
"  The  pulse  variations  and  their  significance," 
which  was  well  received. 

Dr.  Stewart  read  an  able  report  on  a  case  of 
abdominal  section,  for  fibro-cystic  tumour  of  the 
uterus,  on  which  he  operated  28th  of  June 
last.  The  patient  was  a  young  woman,  18 
years  of  age.  Tumour  was  first  noticed  three 
years  ago.  Abdominal  incision  was  10  inches 
long,  pedicle  divided  in  two  by  carbolized  silk 
dropped  back  into  the  abdominal  cavity. 
There  were  no  adhesions.  A  di*ainage  tube 
was  left  in.  Thorough  antiseptic  precautions 
(Listerism)  were  used  throughout.  Had  been 
mistaken  for  an  ovarian  tumour.  Complete 
recovery.  Tumour  weighed  12  lbs.,  which  was 
shown  to  the  members  present. 

Dr.  Standish,  of  Palmerston,  opened  a  dis- 
cussion on  the  etiology  and  treatment  of  diph- 
theria, in  which  the  following  gentlemen  took 
part : — Drs.  Macdonald,  Youmans,  Jones,  Mc- 
Naughton,  Cowan,  Gunn^  Clapp,  Philp,  Beth- 
une,  Collinge,  and  Halsted. 

The  following  resolutions  werepassed  : 

That  two  meetings  be  held  instead  of  three, 
as  at  present,  each  having  three  sessions. 

That  the  next  meeting  be  held  in  Palmer- 
ston, on  the  first  Tuesday  of  Feb.  next. 

That  Drs.  Burgess  and  Graham  prepare  by- 
laws for  the  use  of  the  branch. 

The  following  gentlemen  were  appointed  by 
the  President  to  prepare  papers  for  next 
meeting  : — Drs.  Gunn,  Cowan,  Macdonald,  and 
Holmes. 


Luke  Teskey,  M.B.,  M.R.C.S.,  Eng.,  Prof, 
of  Anatomy  in  the  College  of  Dentistry,  has 
been  appointed  Assistant  Demonstrator  of 
Anatomy  in  Trinity  Medical  School.  We 
regard  the  selection  as  a  subject  of  much  con- 
gratulation to  the  School. 


We  regret  to  have  to  record  the  death,  from 
cancer  of  the  tongue  and  pharynx,  of  Dr.  John 
N.  Reid,  of  Thornhill,  aged  52,  who  was  for 
many  years  Professor  of  Physiology  in  the  old 
Medical  Department  of  Victoria  College. 


350 


CANADIAN  JOURNAL  OF  MEDICAL  SCIENCE. 


^Uisiatlnutouisi. 


Pidoux,   Trousseau's    eminent    collaborator, 
died  in  Paris  on  4th  of  September. 


Erb   succeeds  the   late   lamented    Friedrich 
at  Heidelberg. 


Chiari,  the  new  Professor  of  Pathology  at 
Prague,  is  30  years  old,  and  has  made  8,000 
post-mortem  examinations. 


The  Seventh  Annual  Meeting  of  the  Amer- 
ican Gynoecnlogical  Society  was  held  in  Boston 
on  the  20th,  21st,  and  22nd  of  September. 
Dr.  T.  A.  Emmet,  President,  in  the  Chair. 
Mr.  Knowsley  Thornton,  of  the  Samaritan 
Hospital,  London,  was  pi-esent. 


Mode  of  Administering  Male  Fern. — 
Herr  Dietrich  (Pharm.  Zeituvg)  recommends 
as  most  succeshful  the  administration  of  thp 
extract  along  with  castor  oil.  He  gives  it  in 
flexible  capsules,  each  containing  1  gramme  of 
the  extract,  and  2  grammes  of  oil.  One  dose 
consisting  of  six  such  capsules,  preceded  by  a 
laxative,  is  found  effective. 


M.  Lajoux,  of  Rheims,  found  a  substance  sold 
at  a  very  low  price  under  the  name  of  silvery 
glycerh'e,  which  was  simply  a  saturated  solution 
of  magnesium  sulphate,  (t.  e.,  containing  about 
one  third  of  its  weight  of  the  salt  at  the 
ordinary  temperature,)  sweetened  with  160 
grammes  of  glucose  to  the  litre. — L' Union 
Med.  et  Set  du  Nord-Est. 


The  Medical  Faculty  of  McGill  University 
celebrate  the  opening  of  their  Jubilee  Session 
by  a  Conversazione,  in  the  Peter  Red  path 
Museum,  on  the  4th,  and  a  dinner  at  the 
Windsor  Hotel,  on  the  5th  inst.  "We  heartily 
extend  our  best  wishes  on  the  auspicious  occa- 
sion, and  trust  that  the  Faculty  may  go  on 
and  increase  the  good  work  they  have  been 
doing,  especially  in  the  last  few  years,  in  the 
c.iuse  of  medical  education. 


a  physician  of  the  early  part  of  the  eighteenth 
century.  He  was  famous  for  his  collection  of 
medals,  and  so  enthusiastic  in  this  pursuit, 
that  he  is  reported  to  have  swallowed  six 
ounces  of  medals  to  secure  them  from  the 
Algerines,  when  once  in  danger  of  being  cap- 
tured ;  but  the  wind  changing  in  his  favour 
he  got  safely  on  shore.  When  beginning  to 
be  incommoded  by  his  indigestible  curiosities, 
he  consulted  two  physicians  who  were  puzzled 
by  the  singularity  of  his  case.  Natux-e  how- 
ever relieved  him  from  time  to  time,  and  as 
he  found  himself  in  possession  of  his  treasures, 
he  explained  with  much  pleasure  to  his  friends 
those  already  arrived,  as  well  as  those  he 
daily  expected.  A  valuable  Otho  was  the  last 
that  came  to  hand. 


In  "Wadd's  Nugce,  Chirurgicae  (London,  1824) 
there  is  an  account  of  one  John  Foy  Vaillant, 


PuLViS  Doveri. — People  whose  "  inward 
griefs  and  peristaltic  woes"  have  been  relieved 
by  the  powder  of  Dover,  do  not  generally 
know  to  whom  they  are  indebted  for  this  ex- 
cellent compound.  Doctor  Dover  was  a  friend 
and  probably  pupil  of  the  great  Sydenham. 
He  commenced  practice  in  Bristol,  where  hav- 
ing made  some  money,  he  longed  to  make 
more.  The  Roll  of  the  College  of  Physicians 
tells  us  that  he  joined  with  some  merchants  in 
fitting  out  two  privateers  for  the  South  Seas, 
in  one  of  which,  the  "  Duke"  he  himself  sailed 
from  Bristol,  2nd.  August,  1708.  On  the  pas- 
sage out  they  touched  at  the  Island  of  Juan 
Fernandez,  where  Dover  on  the  2nd.  February, 
1708  9  found  Alexander  Selkirk,  who  had 
been  alone  on  the  island  for  four  years  and 
four  months,  and  whom  Dover  brought  away  in 
the  "  Duke."  In  the  April  following  Dover 
took  Ginaguil,  a  city  or  town  of  Peru,  by 
slorm.  In  December,  1709,  the  two  privateers 
took  a  large  and  valuable  prize,  a  ship  of  20  guns 
and  190  men,  in  which  Dover  removed  from 
the  "  Duke,"  taking  Alexander  Selkirk  with 
him  as  master,  and  finally  reaching  England 
in  October,  1711.  After  this  cruise  Dr.  Dover 
removed  to  London,  where  his  practice  soon 
became  great-  His  patients,  and  the  apothe- 
caries who  wished  to  consult  him,  addressed 
their  letters  to  the  Jerusalem  coffee  house, 
where  at  certain  hours  of  the  day  he  received 
most  of  his  patients. 


THE 


-y» 


Canadian  MmxmI  d 


mut 


A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


U.  OGDEN,  M.D., 

R,  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond, 


}  ^        u-      c-At^.      I         A-  H.  WRIGHT,  B.A.,  M.B.,  M.R.C.S.,  Eng.,  >  s.^,-,.-, 
JCoruul*^^^^'-     I         ,.  H.  CAMERON,  M.B..  ^'^EdUor,. 


8UB8CRIPTI01V,   93    PER    ANlVlTm. 


SS"  All  literary  oommunicatlons  and  Exohanges   should  be  addressed  to  Dr.  CAMKROK,  273  Bherbourne  St 

i^All  business  oommunioations  and  remittances  should  be  addressed  to  Dr.  WRIGHT,  20    Oerrard  Street 
lElast. 


TORONTO,  NOVEMBER,  1882, 


^HflittHl  (Kammttnicati0ttisi, 

DIPHTHERIA. 

BY  JOHN  A,  MULLIN,  M.D.,  HAMILTON. 

(Read  before  the  Canada  Medical  Association, 
Sept.,  1882.) 

In  considering  the  influence  of  treatment  in 
any  disease,  it  is  of  primary  importance  to 
recognize  not  only  that  the  special  disease  is 
present  but  also  the  course  which  it  will  pro- 
bably take  if  no  medication  is  used.  As  regards 
diphtheria  it  is  highly  probable  that  many 
forms  of  treatment  have  obtained  popularity 
because  they  have  been  adopted,  in  some  in- 
stances, when  diphtheria  was  nob  present,  and 
also  in  a  large  number  of  cases  where  the 
disease  was  present  in  a  form  that  would  termin- 
ate favourably  solely  through  the  vis  medicatrix 
Natures.  As  with  measles,  and  scarlatina,  so 
also  with  diphtheria,  there  are  mild  forms ;  in 
other  words  it  occurs  under  circumstances, 
either  constitutional  or  local,  favourable  to 
throwing  off  the  disease.  I  apprehend,  too, 
that  many  cases  have  been  regarded  as  diph- 
theritic where  the  patient  has  suffered  from  an 
inflammatory  affection  of  the  throat,  the  result 
of  what  is  called  a  cold.  During  the  autumn, 
winter,  and  spring  months  we  frequently  find 
patients  suddenly  taken  ill  with  chills,  fever 
from  three  to  four  degrees  above  the  normal, 
soreness  of  the  throat,  redness  and  swelling  of 
the  tonsils,  and  an  exudation  of  a  yellowish 
colour  more  or  less  extensive,  generally  thin, 
in  spots  corresponding  with  the  depressions  of 
the  follicles  and  sometimes  in  small  patches. 
This  form  of  illness  may  affect  two  or  more 


members  of  a  family,  and  its  prevalence  at 
times  in  different  families  distant  from  one 
another  seems  to  indicate  a  dependence 
upon  some  general  influence.  The  symptoms 
are  severe  for,  perhaps,  twenty-four  hours, 
and  then  rapidly  pass  away.  It  is  not 
accompanied  or  followed  by  croup  or  other 
diphtheritic  complications  or  sequelae.  It  differs 
from  the  mild  form  of  diphtheria  in  the  urgency 
of  the  symptoms  at  the  outset,  the  patient's 
being  suddenly  ill  with  a  local  affection  that 
seems  severe,  and  a  high  fever  which  quickly  sub- 
sides ;  while  the  latter  is  attended  with  scarcely 
any  elevation  of  the  temperature  or  acceleration 
of  the  pulse,  and  the  local  symptoms  give  but 
little  trouble.  So  frequently  is  this  the  case 
that  we  are  of<"en  called  when  symptoms  of 
croup  have  appeared  after  the  patient's  com- 
plaining of  symptoms  apparently  due  to  a  cold, 
and  an  inspection  of  the  throat  has  shown  the 
presence  of  diphtheritic  disease.  In  a  family, 
one  of  whose  members  had  died  a  few  weeks 
before  from  diphtheria,  another  child  com- 
plained of  slight  soreness  of  the  throat,  and  an 
examination  of  the  fauces  daily  for  three  days 
discovered  small  spots  of  diphtheritic  deposit. 
There  was  scarcely  any  elevation  of  temperature 
until  the  morning  of  the  £»urth  day,  when 
croup  symptoms  supervened  of  an  alarming 
character,  and  the  child  died  the  next  day. 

A  case  of  diphtheritic  croup  came  under  ray 
care  recently  where  urgent  symptoms  appeared 
after  an  illness  of  only  a  few  days.  G.  H  ,  aged 
6^  years,  had  ague  at  the  end  of  the  previous 
week,  for  which  quinine  was  given  on  Saturday. 
The  following  Sunday  and  Monday  he  ap{)eared 
quite  well ;  on  Tuesday  the  1st  of  August  his 
parents  thought  he  had  a  slight  cold  ;  Wednes- 


352 


CANADIAN  JOURNAL 


day  evening,  alter  being  hoarse  in  the  after- 
noon,, he  presented  symptoms  of  croup,  and, 
on  visiting  him  at  9  p.m.,  I  found  the  temp. 
100,  cough  and  breatiiing  croujjy,  but  not  much 
embarrassment — the  mother  said  he  was  worse 
at  intervals.  The  tonsils  were  a  little  red  ;  on 
the  left  side  there  was  a  slight  chronic  enlarge 
ment ;  no  membrane  could  be  seen.  An  emetic 
of  ipecac  was  given,  with  small  doses  at  in- 
tervals through  the  night ;  hot  applications  to 
the  throat  and  inhalations  of  steam. 

The  lad  had  been  healthy  with  the  exception 
of  ague,  of  a  healihy  family  with  no  indications 
of  hereditary  weakness  ;  he  lived  in  a  cottage 
in  the  suburbs,  the  premises  were  isolated  and 
carefully  kept,  the  unfavourable  influences  to 
which  he  had  been  exposed  were  malarial,  re- 
siding only  one  block  from  the  bay,  and  there 
were  probably  unhealthy  emanations  of  another 
kind  from  the  waters  of  the  inlet,  not  far  dis- 
tant into  which  the  Cathcart  street  sewer  dis- 
charges. 

August  3rd. — Pulse,  100  ;  temperature,  100  ; 
respiration,  36  ;  cough  dry,  breathing  croupy, 
and  appears  to  have  been  much  embarrassed  at 
intervals  through  the  night.  It  was  more  easy 
at  the  time  of  my  visit  in  the  forenoon,  9  a.m_ 
Fauces  somewhat  red,  and  at  one  or  two  spots 
the  appearance  of  the  left  tonsil  was  suspicious^ 
but  no  membrane  was  perceived.  Slight  en- 
largement of  the  glands  behind  the  lower  jaw. 
The  ipecac  and  steam  inhalations  were  con- 
tinued. At  4  p.m.  of  the  same  day,  received 
word  that  the  condition  was  alarming,  and  foiind 
him  breathing  with  very  great  difficulty,  and 
almost  asphyxiated, — temperature,  lOUj.  Chlo- 
roform was  administered,  and  my  friend.  Dr. 
Mai  loch,  performed  tracheotomy.  When  the 
trachea  was  opened,  a  small  piece  of  membrane 
was  expectorate4p  and  the  tube  being  inserted, 
the  difficult  breathing  was  relieved.  The 
trachea  was  opened  below  the  isthmus  of  the 
gland,  and  Foulis's  tubes  were  used, 

August  4th. — Pulse,  109;  respiration,  30; 
temperature,  100^ ;  skin  moist,  respiration 
easy,  no  spasms  in  the  night,  small  portions  of 
membrane  were  coughed  through  tube.  Patient 
was  kept  breathing  the  steam. 

Tr.  fer.  ch.,  pot.  chl.  and  glycerine  given. 

August  5th. — Pulse,  110;   respiration,  24, 


temperature,  100  ;  portions  of  mentbrane  ex- 
pectorated ;  the  tonsils  on  both  sides  show  small 
spots  of  exudation. 

August  6th. — Pulse,  109  ;  respiration,  20  ; 
temperature,  100. 

August  7th. — Pulse,  100;  respiration,  18; 
temperature,  99.    Mucopurulent  expectoration. 

August  8th. — Pulse,   100;  respiration,   18 
temperature,    98J.     Muco-purulent  ex|)ectora- 
tion. 

August  10th. — Pulse,  96  ;  respiration,  18  ; 
temperature,  98J  ;  skin  moist,  tube  removed, 
respiration  easy,  can  speak  with  the  opening 
closed.  The  progress  of  the  case  was  favour- 
able, except  ague  at  the  end  of  second  week — 
two  attacks, — and  the  patient  made  a  good  re- 
covery. 

Wm.  A.  S ,   aged   19,   barber,   had  for 

several  years  enjoyed  good  health  ;  suflFered  from 
measles  and  whooping-cough  in  childhood,  but 
no  illness  of  importance  since,  except  occasion- 
ally a  slight  cold  affecting  the  throat  which 
passed  away  in  a  few  days.  The  family  history 
shows  no  unfavourable  features,  except  the 
death  of  an  uncle  from  phthisis.  The  parents 
are  both  living,  middle  aged  and  healthy.  This 
is  the  only  child.  Residence  on  John  St.  near 
Rebecca,  in  one  of  two  frame  houses  in  a  block, 
the  ceiling  of  first  floor  9  feet,  the  second  less 
than  half  a  story,  house  close  to  the  street,  the 
yard  about  15  feet  square,  the  water-clo.set  12 
feet  from  the  door  of  kitchen,  the  wash-water 
has  been  thrown  into  it,  and  the  tenants  fre- 
quently complained  of  the  foulness  of  the  yard. 

On  the  1st  July  the  lad  went  to  the  beach, 
and  when  the  present  illness  came  on  he 
thought  it  due  to  catching  cold  on  that 
day.  Four  days  afterwards  he  complained 
of  lassitude,  and  the  throat  was  sore  ;  that  day, 
however,  and  the  following,  he  continued  at 
his  usual  work.  On  the  evening  of  Thursday 
the  6th,  the  throat  was  very  painful,  and  he 
was  giddy.  As  the  symptoms  were  growing 
more  severe,  I  was  called  in.  The  tonsil  on 
the  left  side  was  much  swollen,  and  presented 
a  thin  yellowish  film  ;  he  complained  of  severe 
pain,  and  difficulty  of  swallowing,  and  a  sen- 
sation of  choking  ;  the  pulse  100,  temperature 
101°;  skin  dry.  On  the  morning  of  the  next 
day  the  general  symptoms  were  similar  ;  there 


OF  MEDICAL  SCIENCE. 


353 


was  slight  swelling  of  the  glands  behind  the 
jaw;  the  tonsil  more  swollen,  and  also  the 
uvula,  which  was  cedematous  ;  the  yellowish 
exudation  continued  as  on  the  previous  even- 
ing. On  the  8th,  the  glands  behind  the  jaw 
on  the  left  side  were  very  much  swollen,  and 
the  left  tonsil  and  uvula,  more  swollen  than 
before,  presented  a  marked  diphtheritic  mem- 
brane. This  day  an  hoemorrhage  occurred, 
and  a  sanious  discharge  from  the  nostrils  ;  the 
pulse  increased  in  frequency  to  120,  and  the 
temperature  rose  to  102°.  These  syropboms 
continued  for  three  days,  the  discharge  from 
the  throat  being  very  offensive.  Tr.  fer.  chl. 
pot.  chl.  and  glycerine  were  given,  and  each 
morning  ten  grains  of  quin.  sulph.  On  the  11th, 
the  swelling  of  the  tonsil  and  uvula  was  less, 
and  the  membrane  had,  in  great  part,  sepa- 
rated; on  the  12th,  the  membrane  had  dis- 
appeared, leaving  the  tonsils,  pharynx,  and 
uvula  of  a  dark  red  colour,  and  not  much 
swollen  ;  the  pulse  90  per  min.,  temp,  normal ; 
the  patient  had  become  mxich  reduced,  the 
emaciation  being  marked.  On  the  morning  of 
the  13th  my  visit  was  postponed  till  mid-day. 
A  little  before  I  arrived  the  patient's  condition 
seems  to  have  changed  very  much  for  the 
worse  ;  the  parents  stated  that  he  felt  a  chok- 
ing sensation  when  he  attempted  to  swallow 
even  liquids ;  a  teaspoonful  of  water  given 
was  coughed  up  at  once,  mixed  with  bloody 
mucus.  Turning  the  patient  on  his  side,  he 
swallowed  with  less  difficulty,  but  only  a  part 
of  a  teaspoonful  could  be  given  without  excit- 
ing a  spasm  of  coughing  ;  the  temp.  98,  pulse 
45  per  min.,  the  respiration  18,  the  general 
surface  cold,  the  throat  of  a  dusky  red  colour. 
The  urine  had  through  the  illness  been  passed 
in  usual  quantity ;  it  was  now  examined,  and 
found  to  contain  albumen.  The  remainder  of 
this  and  the  two  following  days  the  condition 
continued  similar.  The  emaciation  became 
more  marked  ;  respiration  16-18  per  min.,  pulse 
45,  temperature  subnormal.  Saturday  about 
midnight  the  pulse  was  found  increased  in  fre- 
quency, and  became  more  rapid  and  feeble 
towards  morning;  he  died  about  11  a.m.  the 
16  th. 

Efforts  were  made  during  the  illness  to  clear 
the  throat  with  the  syringe,  using  a  solution  of 


salt,  but  with  little  avail,  for  the  patient  could 
not  be  prevailed  upon  by  his  parents  to  use 
local  treatment,  or  take  the  medicines  as  di- 
rected. The  quantity  of  nourishment  taken  in 
the  form  of  milk  and  beef-tea  was  limited. 
Stimulants  were  ordered,  but  little  taken. 
The  patient  was  at  times  delirious,  but  gener- 
ally spoke  rationally  in  reply  to  questions, 
until  within  a  few  hours  of  his  death. 

These  cases,  so  different  in  their  form,  the 
course  of  the  disease,  and  the  result,  illustrate 
the  different  manner  in  which  the  diphtheritic 
disease  in  its  action  upon  the  system  is  modi- 
fied by  age  and  local  conditions — the  croupy 
form  occurring  in  the  younger,  and  without 
septic  results,  as  he  was  placed  as  regards  resi- 
dence in  a  condition  more  favourable  for  resist- 
ing the  constitutional  effects  of  the  disease ; 
the  other  form,  occurring  in  a  young  man 
whose  days  were  spent  in  an  in-door  occupa- 
tion, and  who  lived  in  a  house  where  hygienic 
requirements  were  to  a  great  extent  neglected. 
The  proper  treatment  for  the  septic  form  has 
an  important  relation  to  that  for  the  croupy, 
for  upon  the  efforts  of  local  and  general  reme- 
dies to  a  great  extent  depends  the  question  of 
the  time  at  which  an  operation  should  be  per- 
formed, for  the  relief  of  the  condition  which 
threatens  to  destroy  life  by  apncea  (asphyxia). 
If  it  is  possible  by  local  means  to  modify  to  any 
great  extent,  and  quickly,  the  disease  in  the 
throat  and  air  passages,  so  much  the  longer  may 
an  operation  be  delayed,  but  if  this  can  not  be 
done,  it  seems  to  me  that,  when  symptoms  of 
laryngeal  or  tracheal  diphtheria  present,  an 
early  operation  is  demanded,  while  the  impor- 
tance of  constitutional  treatment  is  recognized. 
Many  seem  to  think  that  the  disease  may  be 
modified  by  the  use  of  remedies  applied  locally, 
for  on  looking  over  cases  reported,  we  notice 
constantly  the  belief  that  local  applications  are 
of  primary  importance.  It  is  true  the  mem- 
bers of  our  profession  are  far  from  unanimous 
as  regards  the  local  applications  that  are 
thought  most  useful ;  sulphur,  the  sulphites, 
carbolic  acid,  chloral,  tinct.  of  iron,  salicylic 
acid,  borax,  oxalic  acid,  tinct.  of  iodine,  nitrate 
of  silver,  benzoate  of  soda,  creosote,  lime 
water,  phosphate  of  soda,  and  many  other 
medicines,  have  had  the  credit  of  being  spe- 


354 


CANADIAN  JOURNAL 


cially  useful  in  the  treatment  of  diphtheria. 
Each  remedy  is  supposed  to  act  upon  the  dis- 
ease locally,  some  in  one  way,  some  in  another  ; 
one  writer,  essaying  to  attack  the  disease  from 
more  than  one  point,  recommends  a  combina- 
tion of  chloral,  salicylic  acid,  sulphite  of  soda, 
and  glycerine,  and  believes  that  in  it  he  has 
found  that  which  acts  as  "  an  energetic  anti- 
septic, anti-fermentative,  disinfectant,  haemos- 
tatic and  preservative,  as  well  as  a  destroyer  of 
parasitic  organisms."  The  eflScacy  of  local 
remedies  may  be  shown  in  the  modification  of 
the  inflammatory  conditions  which  co  exist 
with  the  diphtheritic  deposit.  In  the  hope  of 
doing  something  in  this  way,  I  have  advised 
inhalations  of  steam,  frequent  spraying  of  the 
throat,  and  the  washing  of  the  inflamed  parts 
with  warm  water,  and  saline  solutions  thrown 
in  with  a  syringe. 

The  inhalations  of  steam  may  be  of  value  in 
cases  where  the  symptoms  refer  to  the  larynx 
and  trachea,  and  in  one  case  where  the 
dyspnoea  was  very  great  through  a  laryngeal 
complication,  the  use  of  the  steam-spray  atom- 
izer was  attended  with  good  results.  Some 
have  placed  value  on  solvents,  as  liq.  potass,  and 
lime  water,  in  the  belief  that  they  will  dissolve 
the  diphtheritic  membrane ;  my  own  trials 
with  liquor  calcis  did  not  succeed  in  dissolving 
the  membrane  expectorated  in  the  case  treated 
recently  ;  some  of  the  mucus  adhering  to  it 
was  dissolved  in  a  few  minutes,  but  there 
)-emained  portions  of  the  membrane  which 
resisted  the  action  of  this  agent  for  a  month. 
Some,  regarding  the  disease  as  due  to  the 
agency  of  low  forms  of  vegetable  life,  hope 
by  destroying  these  to  remove  the  disease. 
I  may  not  be  suflBciently  impressed  with 
recent  theories  regarding  the  action  of  these 
agents  upon  the  human  system.  It  is 
possible  that  the  atmosphere  may  be  the 
abode  of  countless  germs  which  invade  our 
bodies  and  destroy  vitality,  and  that  we  are  to 
a  greater  or  lesser  extent  exposed  to  their  in- 
fluence unless  we  ascend,  as  Prof.  Hueter 
remarks,  "  mountainous  regions,  near  and 
above  the  line  of  perpetual  snow."  If  this  be 
true,  it  would  account  for  the  diflficulty  met 
with  in  the  treatment  of  severe  forms  of  diph- 
theria.    With  respect  to  the  micrococci  present 


in  suppurating  wounds,  Dr.  Ogston  says  that 
"  once  they  have  gained  access  to  a  wound  it  is 
not  easy  to  eradicite  them.  Ordinary  Lister 
dressings  will  not  do  so.  After  weeks  of  dress- 
ing with  carbolic  lotion,  carbolic  oil,  1  to  16, 
and  1  to  8  in  strength  ;  after  the  use  of  dress- 
ings with  boracic  lint,  salicylic  acid,  and 
chloralum,  all  carefully  and  thoroughly  applied, 
they  were  found  in  the  wounds  and  ulcers  in 
nearly  as  great  numbers  as  before,  and  it  was 
clear  that  these  applications,  at  least  as 
ordinarily  employed,  though  generally  snflicient 
to  kill  bacteria  and  bacilli,  are  powerless  to 
eradicate  micrococci.  The  only  way  in  which 
I  succeeded  in  destroying  them  in  wounds 
where  they  had  once  established  themselves, 
was  by  cauterization  with  a  strong  solution  of 
chloride  of  zinc,  or  by  strong  frictions  with  a 
5  per  cent,  watery  solution  of  carbolic  acid." 
The  micrococci  present  in  diphtheria  may  pos- 
sibly be  less  tenacious  of  life,  but  these  low 
forms  of  vegetable  life  seem  to  have  high 
degrees  of  vitality,  the  lower  the  form  the 
higher  the  degree,  for  they  seem  to  exist  and 
survive  where  all  animal  life  dies  ;  and  if  our 
hopes  of  treating  the  disease  with  success  de- 
pends upon  the  agency  of  remedies  applied  to 
the  throat  with  a  view  of  destroying  these 
organisms,  T  think  that  those  who  have  often 
tried  the  influence  of  agents  upon  the  vegetable 
growth  present  in  tinea  tonsurans  will  not  be 
sanguine  of  results  in  combatting  diphtheria  on 
this  line. 

Dr.  Bilkington  says  that  60  per  cent,  of  all 
cases  will  recover  without  treatment,  5  per 
cent  will  die  no  matter  what  treatment  may  be 
employed.  These  figures  show  how  wide  a  field 
there  exists  for  forming  incorrect  conclusions 
as  to  the  usefulness  of  remedies.  There  re- 
mains, however,  a  sufficiently  large  proportion 
of  ca^es  for  us  to  enquire  in  what  manner,  and 
to  what  extent,  the  disease  may  be  influenced 
by  remedies  local  or  general. 

There  seems  some  reason  to  believe  that 
when  it  first  appears  this  disease  is  a  local  one  ; 
it  has  been  produced  by  localized  infection, 
and  it  is  probable  that  it  begins  in  that  part 
where  the  germs  have  been  planted.  But  does 
it  follow  that  by  attacking  it  there  it  will  be 
cured  1     A  chancre  is   produced   in  the  same 


OF  MEDICAL  SCIENCE. 


355 


manner,  so  also  is  the  vaccine  vesicle  ;  but  will 
the  removal  of  either  result  in  the  prevention 
of  the  infection  of  the  system  ?  It  has  not 
been  so  proved.  And  as  diphtheria  is  thought 
to  resemble  them  through  being  caused  by  a 
local  inoculation,  so  it  must  be  held  that  like  in 
these  cases  where  the  local  manifestations  are 
seen  there  has  also  taken  place  a  constitu- 
tional infection.  Ic  has  been  thought  that  if 
the  appearance  in  the  throat  is  destroyed  there 
will  not  be  a  subsequent  extension  to  the 
nearest  glands,  and  thence  to  the  general  sys- 
tem. But  is  it  not  true  that  when  we  notice 
the  slightest  appearance  in  the  throat,  we  find 
also  that  the  glands  are  already  enlarged  1  And 
if  afterwards  the  glands  become  more  and  more 
enlarged,  may  we  not  with  good  reason  refer  it 
to  the  continuance  of  the  effects  of  the  original 
irritation.  I  do  not  doubt  that  the  absorption 
of  the  results  of  decomposition  in  the  throat 
may  aggravate  the  glandular  swelling  and  still 
increase  the  blood-poisoning,  whatever  that 
may  be.  And  a  recognition  of  this  possibility 
will  lead  us  to  adopt  those  local  measures  which 
will  tend  to  prevent  such  consequences,  al- 
though not  expecting  thus  to  cure  the  disease. 
It  seems,  therefore,  altogether  opposed  to  the 
analogies  we  have  to  regard  diphtheria  as  a 
local  disease  at  that  stage  when  it  comes 
under  our  observation.  Could  we  at  the 
moment  when  the  germ  is  implanted  recognize 
the  fact,  it  might  be  reasonable  to  place  great 
value  on  those  remedies  which  act  locally,  but 
from  the  coiisiderations  which  occur  to  my 
mind,  it  seems  that  we  err  if  we  fail  to  recog- 
nize the  disease  as  one  involving  a  constitu- 
tional infection ;  and  that  we  should  treat  it 
upon  the  same  principles  as  guide  us  in  the 
treatment  of  similar  diseases,  using,  it  may  be, 
local  remedies  to  prevent  putrid  collections) 
but  not  expecting  through  their  action  to 
remove,  antagonize,  or  dissolve  away  the 
disease. 


The  death  of  Staff-Surgeon  W.  St.  George 
Davis,  R.N.,  is  announced,  at  the  great  age  of 
96.  He  entered  the  Royal  Navy  in  1 806,  and 
was  present  at  many  of  the  great  naval  battles 
of  the  early  pai't  of  the  century. 


SOME  MISTAKES  TO  BE  AVOIDED  IN 

DEALING  WITH  DISEASES  OF 

THE  NOSE  AND  THROAT. 

BY  T.  WESLEY  MILLS,  M.A.,  M.D.,  L.R.C.P.,  LOND. 

Assist,  of  the  Prof,  of  Physiology,  McGill  College  ; 

formerly  Clinical  Assistant  at  the  Throat  and 

Chest  Hospital,  London,  England- 

(Read  before  the  Canada  Medical  Association,  Toronto,  Sept.,  188S. 

That  noses  differ  in  external  characteristics 
widely  enough  has  been  a  matter  of  such  ob- 
servation as  has  been  turned  to  the  widest 
account  by  literary  writers;  but  that  noses 
assert  their  individual  idiosyncracies  strongly, 
as  they  come  under  the  notice  of  the  physician, 
has  not  been  very  clearly  pointed  out,  and  yet, 
I  venture  to  think,  that  there  is  no  organ  in 
the  body  of  which  this  holds  true  to  a  greater 
extent  than  of  the  nose.  One  is  constantly 
learning  that  applications  that  are  too  strong 
for  certain  cases  are  scarcely  felt  by  others, 
belonging,  apparently,  to  the  same  pathological 
class.  This  may  be  owing  to  imperfect  diag- 
nosis ;  yet  such  can  scarcely  be  the  whole  ex- 
planation. The  treatment  of  catarrh  has  been, 
upon  the  whole,  so  unsatisfactory,  that  many 
physicians  have  reluctantly  adopted  the  in- 
curability of  nasal  catarrh  as  an  unwelcome 
article  of  their  medical  creed  ;  and  this  is  the 
first  serious  mistake  the  practitioner  is  liable 
to  commit.  It  paralyses  the  physician  and 
discourages  the  patient.  Catarrh  is  a  most  in- 
tractable disease,  but  it  should  not  be  pro- 
nounced incurable,  unless  we  also  class  under 
that  division  a  large  number  of  diseases,  for 
which  we  profess  to  be  able  to  do  much.  I  am 
not  sure  that  the  term  catarrh,  or  nasal  catarrh, 
applied  as  it  is  to  so  many  various  forms  of  dis- 
ease of  the  nasal  cavities,  and  with  much  less 
accuracy  than  the  term  Bright's  disease  is  to  a 
certain  class  of  disorders  of  the  kidneys,  is  not 
responsible  for  some  of  the  unsatisfactoriness 
in  connection  with  the  class  of  diseases  in 
question.  The  term  is  very  vague ;  it  may 
cover  much  ignoi-ance  ;  it  allows  of  a  very  ready, 
but  a  very  imperfect,  diagnosis — in  fact,  such 
a  term  is  in  every  way  bad,  and  should  be  only 
applied  in  a  transitional  state  of  knowledge. 
To  ask  is  catarrh  curable,  seems  to  me  about  as 
vague  a  question  as  to  ask  is  Bright's  disease 


356 


CANADIAN  JOURNAL 


curable)  Is  lung  disease  curable?  Holding, 
then,  that  the  nasal  cavities  may  be  the  seat 
of  a  great  number  ot  diseases  more  or  less 
allied,  or  if  you  will,  of  many  fctages  of  one 
disease,  so  different  in  character,  however,  as 
to  require  the  widest  diversity  of  treatment,  it 
must  be  evident  that  to  manage  them  success- 
fully, the  diagnosis  must  be  accuratt- ;  the  more 
so  beca.se  the  nose  is  the  most  exposed  organ 
in  the  whole  body,  in  fact,  the  only  one  that  is 
so  constantly  exposed  to  every  injurious  influ- 
ence that  may  float  along  on  the  ever-present 
atmosphere.  Its  mazy  recesses  are  peculiarly 
ill-adapted  for  perfect  scrutiny,  and  every  help 
of  artificial  light  and  mechanical  contrivance 
is  needed  to  overcome  the  natural  difliculties. 

The  limits  of  this  short  general  paper  will 
not  permit  of  a  discussion  of  instruments. 
What  is  required,  is,  of  course,  such  arrange- 
ments of  light,  and  such  appliances  as  will  give 
the  observer  a  perfect  view  of  the  whole  ot 
the  nasal  cavities  and  the  whole  of  the  naso- 
pharynx. Now,  no  single  form  of  speculum, 
or  other  similar  instrument,  answers  this  pur- 
pose in  every  case  ;  what  is  most  suitable  for 
one  case,  or  under  certain  circumstances,  may 
be  quite  inadequate  in  another.  But,  after  all, 
is  not  the  best  instrument  any  physician  can 
carry  about  with  him,  or  keep  in  oflice,  a  strict 
medical  conscience.  If  he  has  that,  he  is 
pretty  sure  to  get  the  other  necessary  ones, 
and,  what  is  of  more  importance,  to  use  them. 
In  no  case  should  any  individual  be  subjected 
to  treatment  for  what  he  may  call  catarrh  till 
he  has  been  submitted  to  as  careful  a  physical 
examination  as  the  practitioner  can  make ;  for, 
with  an  organ  so  extremely  sensitive  as  the 
nose,  a  very  little  treatment,  if  wrong,  may  do 
very  much  harm,  possibly  of  a  permanent  kind. 
Nor  should  this  examination  be  confined  to  the 
field  within  view  from  the  front,  but  the  rhino- 
scope  should  picture  the  condition  of  the  naso- 
pharynx, for  the  major  part  of  the  trouble  may 
be  in  this  region.  As  this  application  of  the 
laryngeal  mirror  is  not  in  all  cases  easy,  even 
in  practised  hands,  it  is  well  in  cases  of  doubt 
to  pass  the  finger  up  gently,  but  decidedly,  be- 
hind the  soft  palate,  and  explore  by  touch.  If 
this  be  done,  growths  (and  adenoid  vegetations 
are  not  uncommon)  can  scarcely  escape  detec- 


tion. Some  people  have  a  pleasing  belief  that 
they  are  accompanied  by  an  invisible  good 
spirit  that  over  manifests  a  benevolent  interest 
in  their  welfare ;  whether  they  believe  equally 
or  at  all  in  the  presence  of  a  corre8j)onding 
evil  agency,  I  know  not ;  but  if  there  be  such 
a  spirit  that  dogs  the  footsteps  of  the  medical 
man,  especially  when  he  has  arrived  at  that 
stage  of  development  designated  by  the  pros- 
perity suggesting  term,  "busy  practitioner" — 
I  say,  if  there  be  such  a  spirit,  it  is  the  demon 
of  routine  in  practice ;  and  'tis  so  seductive  a 
devil,  one  may  be  led  half-way  to  medical  per- 
dition without  knowing  anything  of  his  scien- 
tific longitude.  Now,  if  any  one  organ  has 
suffered  from  routine  treatment  it  is  the  nose; 
of  course,  I  speak  of  the  dark  ages  that  [)re- 
ceded  our  time.  It  would  be  interesting  to 
know  how  many  cases  of  catarrh  so-called  have 
been  treated  without  the  nasal  douche  or  some 
of  its  modifications.  So  common  has  this 
treatment  been,  that  the  laity  have  caught  the 
belief  of  its  necessity  and  acted  upon  it.  Lately 
I  had  a  case  of  this  kind  who  had  carried  out 
this  treatment  with  a  vengeance.  He  did  not 
use  the  favourite  "  teaspoonfnl  of  salt  in  a  cup- 
ful of  lukewarm  water,"  but  he  used,  as  he 
said,  "plenty  of  salt  and  cold  water,"  by  insuf- 
flation, on  the  advice  of  a  lay  friend.  The 
result  corresponded  with  the  treatment.  In  a 
week  he  had  painful  disease  of  both  ears — otitis 
media — I  take  it,  and  now,  some  months  after, 
he  has  thickening  and  opacity  of  both  drum- 
heads, and  can  hear  the  watch  only  at  three 
inches.  After  careful  observation  on  others, 
and  some  experiments  on  myself,  as  to  the 
effects  of  the  introduction  of  such  fluids  as  are 
commonly  used  for  cleansing  and  medication, 
by  the  anterior  nasal  douche  on  the  syphon 
principle,  and  by  insufflation  or  sniffling  of 
fluid  I  conclude  that:  (1)  In  a  large  number 
of  cases  no  douche  or  other  form  of  cleansing 
apparatus  of  such  kind  is  at  all  required.  (2) 
That  as  a  means  of  medication  the  anterior 
nasal  douche  is  a  failure.  (3)  It  is  not  free 
from  danger,  especially  in  the  hands  of  the 
ignorant  and  obtuse  patient,  and  the  danger  is 
greatly  increased  if  tliere  is  any  sort  of  obstruc- 
tion in  the  nasal  passages.  (4)  Neither  th» 
nasal  douche  nor  insufflation  perfectly  cleanses 


OF  MEDICAL  SCIENCE. 


357 


the  naso-pharynx ;  the  former  least  so.  (5)  The 
long  continued  and  frequent  use  of  a  douche 
produces  nasal  thickening.  The  same  remarks 
apply  to  the  insufflation  of  liquids,  the  danger, 
perhaps,  being  greater,  as  by  the  effort  to  draw 
up  the  fluid  the  muscles  of  the  pharynx  are  called 
into  action,  and  the  Eustachian  tube  may  be 
opened  and  the  fluid  sucked  up  into  the  middle 
ear.  The  posterior  nasal  douche  is  less  danger- 
ous, but  is  difiicult  and  unpleasant  to  use,  and 
in  some  cases  it  duces  neuralgia,  itc.  As  a 
general  rule  douches  may,  I  think,  be  con- 
sidered unnecessary  in  the  treatment  of  catarrh; 
if  a  cleansing  apparatus  requires  to  be  used  at 
all,  an  atomizer,  throwing  a  continiious  spray, 
applied  either  anteriorly  or  posteriorly,  accord- 
ing to  circuinstances,  is,  perhaps,  the  best. 
When  the  secretions  are  fetid,  or  hardened  in- 
to crusts,  or  acrid  and  corroding,  they  must,  of 
course,  be  removed  by  some  such  means,  but 
an  abundance  of  secretion  does  not  necessarily 
imply  the  use  of  any  form  of  detergent  appar- 
atus. The  limits  of  this  paper  will  not  admit 
of  my  dwelling  on  the  reasons  for  these  con- 
clusions, but  they  are  shared,  I  find,  by  more 
than  one  recent  writer  of  extensive  experience 
in  this  class  of  diseases.  But  the  actual  harm 
produced  by  the  long-continued  use  of  the 
means  referred  to,  in  producing  infiltration  and 
consequent  thickening  of  the  mucous  and  sub- 
mucous tissue  of  the  nose,  is  a  most  serious 
matter,  and  does  certainly  occur.  If  the  n  sal 
douche  and  kindred  agencies  are  employed,  the 
patient  should  be  most  carefully  instructed  in 
all  details  as  to  its  use.  The  temperature  and 
specific  gravity  of  the  fluid  to  be  used  are  mat- 
ters of  great  moment ;  moreover,  as  indicated 
before,  individuals  so  differ,  that  no  absolute 
rule  can  be  laid  down  for  every  one.  I  am  now 
satisfied  that  a  large  number  of  cases  of  nasal 
catarrh  would  be  benefited  by  constitutional, 
in  addition  to  local,  treatment ;  and,  in  some 
cases,  it  is  doubtful  whether  a  cure  can  be 
effected  without  the  use  of  internal  remedies. 
It  would  be  a  mistake  to  treat  a  case  of  catarrh 
without  having  ascertained,  with  ordinary 
minuteness,  the  habits  of  the  individual  affected, 
for  these  may  be  such  as  to  constantly  undo 
what  the  treatment  effects.  Inquiries  in  re- 
gard to  the  air  habitually  breathed,  and  as  to 


whether  there  be  exposure  to  draughts  or  other 
causes  of  chill,  are  especially  important.  Cold- 
ness of  the  lower  extremities' is,  in  some  persons, 
a  very  powerful  agency  in  inducing  and  per- 
petuating catarrh.  However,  the  causation  of 
this  malady  is  a  subject  requiring  much  more 
investigation,  and  is  one  of  those  questions  on 
which  a  society  like  this,  with  representatives 
from  so  many  different  localities,  might,  I  would 
suggest,  throw  some  light. 

II. — Diseases  of  the  Throat. 

Allusion  will  be  made  to  but  one  form  of 
acute  disease  of  the  pharynx,  because  mistakes 
are  not  so  commonly  made  in  the  treatment  of 
acute  diseases  of  the  throat  as  of  the  chronic 
forms.  Cases  in  which  the  tonsils  are  some- 
what, perhaps,  only  slightly  enlarged,  but  are 
several  times  a  year  the  subject  of  inflamma- 
tion, generally  accompanied  by  acute  pharyn- 
gitis, and  occasionally  by  acute  laryngitis,  are 
not  very  rare.  Individuals  are  met  who  have 
been  thus  troubled  for,  pei'haps,  fifteen  or 
twenty  years.  A  close  inspection  of  the  ton- 
sils, even  when  the  patient  is  free  from  an 
attack,  reveals  a  pitted  condition  of  these 
organs — the  little  follicles  being  filled  with  in- 
spissated whitish  secretion.  Now,  instead  of 
touching  such  tonsils,  which  are  always  the 
starting-point  of  the  mischief,  with  nitrate  of 
silver  or  other  caustic,  why  not  remove  by 
operation  the  diseased,  and,  therefore,  worse 
than  useless  parts,  and  thus  prevent  repeated 
attacks  of  the  disease  extending,  it  may  be, 
through  the  third  of  a  lifetime  1  1  cannot  help 
thinking  it  is  a  radical  mistake  to  leave  such 
tonsils  without  operative  treatment.  But,  al- 
though the  throat  specialists  of  largest  experi- 
ence are  unanimous  on  the  question  of  excision 
of  tonsils,  the  general  profession  is,  perhaps, 
rather  conservative  in  this  particular  still. 
There  is  a  good  deal  of  prejudice  with  the  pub- 
lic in  regard  to  operative  measures  applied  to 
these  comparatively  unimportant  structures  i 
part  of  this  may  be  due  to  clumsy,  slow,  and 
otherwise  defective  modes  of  procedure.  Had 
there  been  any  serious  objection  to  abscision  of 
the  tonsils,  when  mischief  plainly  arises  from 
their  presence,  it  would  be  natural  to  suppose 
that    those,   whose    experience    extends    over 


358 


CANADIAN  JOURNAL 


thousands  of  cases,  would  have  ascertained  and 
stated  that  objection.  This  subject  of  tonsil- 
otomy  is  an  intoi'esting  and  important  one,  as 
well  as  uvulotoniy,  but  this  pajier  does  not 
pretend  to  be  more  than  suggestive  on  any 
point.  With  regard  to  excioion  of  the  uvula, 
there  is  one  point  of  very  great  importance, 
and  that  is,  the  amount  to  be  removed.  The 
action  of  the  soft  palate  is  important  in  speak- 
ing and  singing,  as  well  as  in  swallowing,  while 
it  is  regulated,  and  its  action  completed,  so  to 
speak,  by  the  uvula.  I  think  it  may  be  laid 
down  as  a  principle  to  follow,  that  only  so 
much  of  the  uvula  ought  to  be  removed  as  is 
necessary  to  leave  a  stump  which,  when  healed, 
will  be  of  the  length  of  the  uvula  originally, 
and  not  shorter.  There  is  a  certain  amount  of 
retraction,  of  course,  after  operation,  and  this 
must  be  allowed  for.  One  occasionally  meets 
with  an  almost  entire  absence  of  uvula  as  the 
result  of  operation.  Allow  me  to  repeat  that, 
slight  as  this  operation  may  seem,  it  appears  to 
me  to  be,  especially  in  the  case  of  those  who 
use  the  voice  in  singing  or  public  speaking,  a 
matter  of  the  most  serious  character.  As  it  is 
of  the  utmost  importance,  both  in  tonsilotomy 
and  uvulotomy,  for  the  operator  to  see  exactly 
what  he  is  about,  the  best  illumination  possible 
should  be  employed,  and,  as  a  rule,  this  will 
mean  artificial  light  and  a  good  reflector. 

CHRONIC    PHARYNGITIS 

is  a  disease  so  common,  it  may  be  assumed, 
that  cases  fall  to  the  care  of  every  physician. 
To  treat  this  and  other  forms  of  throat  disease 
so  much  more  with  nitrate  of  silver  than  other 
remedies,  is  one  of  the  mistakes  from  which  we 
are  not  yet  free.  The  general  swab-around  of 
all  the  parts  beyond  the  base  of  the  tongue — 
the  latter  getting  a  liberal  share  of  attention 
in  the  general  struggle,  while  the  patient  is 
half-choked — is  a  method  of  treatment  which, 
though  not  extinct,  need  only  be  mentioned  to 
be  condemned.  Such  treatment  might  be  con- 
sidered justifiable  in  the  case  of  a  young  child 
with  whom  no  better  can  be  done  ;  but  in  the 
case  of  an  adult,  with  a  chronic  disease,  there 
is  no  excuse  for  such  procedure.  It  is  impor- 
tant to  ascertain  in  a  case  of  pharyngitis, 
whether  it  has  extended  from  the  naso-pharynx ; 


it  will  be  always  advisable  to  make  inquiries 
in  regard  to  present  or  previous  naso-pharyngeal 
catarrh.  If  the  latter  has  existed,  before  a 
cure  can  be  considered  comjjlete,  the  naso- 
pharynx will,  in  all  probability,  require  treat- 
ment. In  my  own  experience,  the  sprays 
recommended  in  the  books  for  pharyngitis  are 
much  too  weak.  To  be  of  any  serious  value  I 
find  that  a  spray  must  possess  the  strength  of 
XX  to  XXX  grs.  to  the  oz.  of  water,  <fec.,  at 
least.  There  is  but  little  time  left  me  to  speak 
of  the  larynx ;  in  fact,  I  shall  condense  my 
remarks  into  three  or  four  propositions,  if  you 
will  have  the  goodness  to  excuse  so  dogmatic  a 
form.  (1)  In  all  cases  of  j)hthisi8,  or  suspected 
phthisis,  the  laryngoscope  should  be  used  early, 
and  if  there  be  catarrh  or  congestion  of  the 
larynx,  treatment  should  be  carefully  applied. 
(2)  The  attempted  local  application  of  remedies 
to  the  larynx,  by  means  of  brush,  probang,  &c., 
without  the  use  of  the  laryngoscope  to  guide 
the  hand,  is  inefficient,  unscientific,  and  danger- 
ous. What  would  be  thought  of  such  treat- 
ment in  the  case  of  the  uterus  or  rectum, 
organs  far  less  sensitive  and  vital  1  (3)  The 
laryngoscope  should  be  used  to  make  the  di»g-» 
nosis  in  all  cases  of  dysphonia  or  aphonia, 
lasting  longer  than  ten  days  at  the  most. 
Within  six  months  I  have  met  two  cases  of 
serious  foreign  growths  on  tlie  vocal  cords,  that 
were  overlooked  through  neglect  of  this  pre" 
caution.  (4)  In  the  case  of  public  speakers 
and  singers,  especially,  who  sufier  during  func- 
tional use  of  the  voice  from  hoarseness,  «fec.,  it 
is  of  the  greatest  importance  to  get  all  the 
parts  of  the  throat  above  the  larynx  into  good 
condition,  as  the  laryngeal  mischief  is  generally 
a  result,  in  fact,  a  sort  of  reflex  of  the  disease 
in  the  parts  indicated.  This  class  of  patients, 
however,  not  infrequently  requires  on  the  part 
of  the  physician,  not  only  considerable  skill 
and  experience,  but  special  natural  and  acquired 
abilities  ;  in  fact,  it  is  well  that  he  should 
know  both  theoretically  and  practically,  at 
least  a  little  of  the  arts  that  engage  both  the 
niusician  and  the  public  speaker. 


Rossbach    has    been   called   to  Jena    to    fill 
Nothnagel's   place. 


OF  MEDICAL  SCIENCE. 


359 


NOTES    ON   THERAPEUTICS   AND 
PHARMACOLOGY. 

BY    R.  L.   MACDONELL,  B.A.,  M.D.,  M.R.C.S. 

(Assistant  Demonstrator  of  Anatomy  in  McGill  Col- 
lege.    Physician  to  the  Montreal  Dispensary.) 

THE  ABORTIVE  TREATMENT  OF  GONORRHCEA. 

There  are  many  remedies  for  gonorrhoea. 
Thirty  eight  are  mentioned  in  Dunglison's 
Practitioner's  Reference  Book.  Mr.  Cheyne, 
in  a  recent  number  of  the  Lancet,  describes  a 
new  abortive  treatment,  which  is  based  on  the 
theory  of  a  germ  origin  of  the  disease. 

All  surgeons  nowadays  are  agreed  in  con- 
demning the  old  abortive  treatment,  the  injec- 
tion of  a  strong  solution  of  nitrate  of  silver,  in 
order  to  thoroughly  alter  the  nature  of  the 
inflammation. 

In  estimating  the  value  of  any  particular 
line  of  practice,  we  must  remember  that  the 
greater  part  of  our  success  depends  upon  the 
condition  of  the  general  health  of  the  patient. 
Rest  in  bed  is  half  the  battle.  Mr.  Cheyne 
does  not  say  whether  his  patients  were  kept 
quiet,  or  whether  they  followed  their  daily 
occupations  while  under  treatment. 

An  antiseptic  urethral  bougie  is  the  engine 
of  destruction  by  which  the  gonorrhoea  germ 
is  to  be  killed.  This  is  to  be  made  four  or  five 
inches  long  and  about  as  thick  as  a  No.  10 
catheter.  It  should  contain  five  grains  of 
iodoform,  ten  minims  of  eucalyptus  oil  to  about 
forty  grains  of  cacao  butter. 

The  patient  is  told  to  pass  water  ;  he  then 
lies  down  and  an  iodoform  and  eucalyptus  rod 
is  dipped  in  eucalyptus  oil  and  passed  into  the 
urethra,  a  small  pad  of  boracic  lint  is  applied 
over  the  orifice,  outside  this  a  large  piece  of 
gutta  percha  tissue,  the  whole  being  fastened 
on  by  strapping.  He  is  told  to  allow  this  to 
remain  on  as  long  as  he  can,  generally  about 
five  or  six  hours.  He  then  takes  it  ofi",  passes 
water,  injects  one  or  two  syringefuls  of  the 
sulpho-carbolate  of  zinc  solution  (two  grains  to 
the  ounce),  and  if  the  case  is  very  acute  another 
rod  is  introduced.  Afterwards  the  injection  is 
to  be  used  as  often  as  possible,  six  or  seven 
times  a  day,  always  pa-sing  water  before  its 
use  ill  case  any  infective  material  should  remain 


in  the  urethra,' which  might  be  driven  back 
before  the  injection.  Boracic  lint  is  to  be 
placed  under  the  prepuce.  Purgatives  and 
salines  to  be  given.  Mr.  Cheyne  is  a  believer 
in  the  efficacy  of  copaiba  (half  a  drachm  three 
times  a  day).  After  the  acute  symptoms  have 
subsided  an  astringent  injection  is  to  be  sub- 
stituted for  that  of  the  carbolate  of  zinc. 

Fifty-one  hospital  patients  were  treated, 
more  or  less  in  the  way  described  In  forty- 
one  the  average  time  from  the  commencement 
of  the  treatment,  until  complete  cessation  of 
the  discharge  was  9.9  days.  Of  these  four  cases 
lasted  longer  than  14  days,  being  18,  26,  28,  30 
days  respectively  under  treatment. 

The  results  are  thus  summed  up  ; — This 
treatment  has  the  effect  in  the  great  majority 
of  cases  of  acute  gonorrhoea,  of  checking  the 
acute  symptoms  in  a  day  or  two,  and  bringing  the 
disease  rapidly  to  a  chronic  stage,  thus  avoiding 
all  the  risks  dependent  on  the  violence  of  the  in- 
flammation. The  discharge  at  this  time  is 
amenable  to  treatment,  and  gets  rapidly  well 
under  the  use  of  suitable  remedies.  The  essen- 
tial parts  of  the  method  are  the  use  of  the 
bougie  and  the  injection  ;  but  the  rapidity  of 
cure  is  much  aided  by  commencing  the  use  of 
copaiba  or  sandal  wood  at  once.  This  method 
may  be  employed  at  any  stage  of  the  disease, 
but,  according  to  the  experience  of  its  originator, 
only  of  use  before  or  during  the  acute  stage  up 
to  (say)  the  eighth  day.  The  result  is  the  more 
marked  the  more  acute  the  inflammation,  the 
rapid  subsidence  of  the  inflammatory  symptoms 
being  very  striking. 

With  regard  to  the  efficacy  of  balsam  of 
copaiba  in  gonorrhoea  some  practitioners  have 
doubts.  The  following  case  certainly  proves 
the  fact  that  it  has  a  specific  effect  upon  the 
urethra.  One  of  my  patients  aged  22,  came  to 
me  on  the  13th  October,  1881,  with  a  recently 
contracted  gonorrhoea.  I  ordered  him  a  purge 
and  directed  him  to  inject  frequently  with  a 
very  weak  chloride  of  zinc  solution.  The  dis- 
charge was  very  slight  at  the  end  of  a  week, 
but  it  persisted  until  the  28th  November. 
There  had  been  no  bubo,  chordee,  or  marked 
ardor.  On  that  day  I  gave  him  pills  of  copaiba 
(McKesson  and  Robins)  ordering  him  three  to 
be  taken  on  the  first  day,  five  on  the  second, 


360 


CANADIAN  JOURNAL 


six  a  daj  afterwards.  The  usual  dose  is  one  to 
four  pills  thrice  daily.  On  the  third  day,  the 
six-juU  day,  the  discharge  suddenly  became 
copious,  and  purulent.  The  prepuce  became  in- 
flamed, phimosis,  scalding,  and  inguinal  tender- 
ness set  in.  In  fact  there  was  all  the  appear- 
ance of  a  severe  new  attack.  The  disicharge 
continued  to  be  free  for  about  a  month.  For 
some  months  afterwards  there  was  a  slight  gleet. 
There  was  no  chance  in  this  case  of  the  attack 
having  been  a  really  fresh  one,  for  dependence 
can  be  placed  on  the  patient's  statement  that 
such  was  not  the  case. 

THE     TREATMENT     OF     PHTHISIS     BT    ANTISEPTIC 
INHALATIONS. 

The  recent  discoveries  as  to  the  nature  of 
tubercle,  lead  us  to  suppose  that  we  have  in  hand 
a  solution  of  the  problem  as  to  how  it  ought  to 
be  treated.  A  spray  of  a  germicide  solution 
would  destroy  the  bacteria  and  with  them  the 
disease.  Disappointment  is  likely  to  follow 
this  expectation.  Dr.  Saundby,*  a  man  who  has 
had  much  experience  with  consumptives,  states 
that  the  iuhalation  treatment,  though  a  valuable 
and  rational  method  for  allaying  cough,  dimin- 
ishing expectoration,  and  indirectly  promoting 
the  healing  of  the  inflamed  and  ulcerated  pul- 
monary tissues,  has  not  led  him  to  modify  his 
views  as  to  the  gravity  of  the  prognosis  of 
pulmonary  consumption 

Antiseptic  surgery  is  a  different  thing  from 
antiseptic  medicine.  The  Listerian  uses  his 
carbolic  acid  to  prevent  the  formation  of  germs, 
while  in  tubercular  phthisis  we  attack  a  citadel 
of  which  the  enemy  is  in  full  possession.  And 
again,  as  Dr.  Saundby  points  out,  surgeons  have 
not  found  that  carbolic  acid  is  of  any  special 
service  in  the  treatment  of  surgical  tubercular 
disease;  cod-liver  oil  and  sea  air  are  still  needed 
to  promote  the  healing  of  wounds  in  stnimous 
subjects  ;  and  finally  but  by  no  means  least  in 
importance,  antiseptics  are  known  to  be  of 
small  value  when  the  wounded  surfaces  have 
been  for  some  time  exposed  to  the  air,  especially 
when  they  are  deep-seated,  irregular,  and 
practically  out  of  reach. 

The  j'iscovery  of  a  parasite  is  not  the  dis- 
covery of  a  remedy.     Germicide  remedies  have 

*  Practitioner,  September. 


been  found  to  be  of  no  special  advantage  in 
diphtheria. 

"  We  do  not  possess  a  cure  for  relapsing 
fever  or  anthrax,  nor  has  it  been  worth  any 
one's  while  to  announce  that  Eklund's  discovery 
of  the  bacillus  leprae  is  the  foreshadowing  of 
knowledge  mightier  still,  which  shall  cleanse 
the  leprous  skin,  heal  the  ulcered  limbs,  restore 
the  blighted  features,  and  make  the  flesh  again 
like  the  flesh  of  a  little  child." 

It  behooves  us,  then,  to  set  about  the  study 
of  the  remedies  likely  to  effect  the  desired  ob- 
ject. Dr.  Robert  J.  Lee  {British  Medical 
Journal,  June  24,  1882)  throws  out  a  few 
useful  suggestions.  After  many  experiments 
he  finds  that  carbolic  acid  is  the  only  antiseptic 
as  far  as  I  know  which  can  be  volatilized  in  a 
definiteand  constant  manner.  If  asolutionof  one 
part  of  carbolic  acid  in  80  of  water,  be  distilled 
under  slight  pressure,  the  vapour  will  contain 
the  same  proportion  of  the  acid  as  the  solution 
during  the  process  of  boiling  ;  so  that  we  can 
obtain  vapour  of  any  strength  and  diffuse  it  in 
the  atmosphere. 

It  is  necessary  to  observe  that  vapourizing  a 
solution  in  the  form  of  spray  does  not  volatilize 
the  antiseptic  to  any  great  extent,  since  the 
dew  settles  quickly  upon  the  nearest  surfaces, 
and  does  not  rise  and  diffuse  itself  as  the  vapour 
of  steam  does. 

But  many  observers  doubt  the  benefit  of 
steaming  inhalations.  Dr.  Coghill  is  convinced 
that  the  steaming  process  is  not  only  ineflScient, 
but  in  every  respect  positively  injurious.  It 
relaxes  the  tissues  with  which  the  vapour  comes 
into  contact ;  it  encourages  suppuration  where 
the  ulcerative  process  has  begun,  and  it  tends, 
therefore,  to  increase  expectoration  and  cough 
and  consequently  the  distress  and  exhaustion 
of  the  patient.  Moreover,  there  is  risk  from  the 
exposure  of  the  air  passages  to  air  of  a  lower 
temperature  after  hot  inhalation. 

Dr.  Coghill's  antiseptic  solution  for  inhaling 
is  as  follows  :  li.  Tinct.  iodi  etherealis,  acidi 
carbolic,  aa.3ii;  creasoti  vel  thymoli,  3i ',  spiritus 
vini  rectificati,  ad  gi,  M.  Where  cough  is 
urgent,  or  breathing  embarrassed,  chloroform 
or  sulphuric  ether  may  be  added  at  discretion.* 

Dr.  Hunter    Mackenzie's    plan   is   to   insist 

"  British  MedicalJoumal,  May  28th,  1881,  p.  841. 


OF  MEDICAL  SCIENCE. 


361 


upon,  conlinuous  iuhalatiou.  Intertiiittiug 
spraying  or  inhaling  does  not  produce  the  same 
result.  Creasote  is  his  favourite,  used  either 
pure  or  dissolved  in  one  to  three  parts  of  recti- 
fied spirit.* 

Dr.  W,  Williams'  apparatus  is  a  wire  frame- 
work which  goes  over  mouth  and  nose  covered 
with  carbolic  gauze.  The  whole  affair  is  dipped 
into  a  watery  solution  of  carbolic  acid  of  the 
strength  of  1  in  4.0  ;  the  gauze  itself  being 
renewed  every  two  or  three  days.  The  respirator 
should  be  worn  constantly.! 

Dr.  S.  Wilson  Hope's  suggestion  is  a  good 
practical  one.  His  plan  requires  no  special 
apparatus  and  costs  nothing.  Cut  from  an 
ordinary  roll  of  wadding  two  pieces  large 
enough  to  cover  the  nose  and  mouth.  A 
diamond  shape  answers  very  well.  Now 
remove  the  skin  like  substance  which  coats  the 
pieces ;  put  them  together  and  fold  them  in  a 
piece  of  thin  muslin,  to  the  end  of  which  ribbons 
may  be  sewed,  and  your  inhaler  is  made.  Dr. 
Hope  has  used  it  for  the  last  two  years,  direct- 
ing the  patient  to  drop  five  or  ten  drops  of 
creasote  between  the  layers  of  wadding,  fold  it 
in  the  muslin,  and  to  wear  it  for  half  an  hour 
two  or  three  times  a  day,  or  sometimes  through 
the  night.  It  is  useful  in  many  cases  of  phthisis, 
in  some  cases  of  chronic  bronchitis,  and  in  some 
cases  of  diffuse  capillary  bronchitis  in  young 
people.  I 

The  strength  of  the  agents  to  be  used  in  these 
different  modes  of  inhalation  is  as  follows  : 
Amyl.  nitrite,  pure  for  adults  ;  one  in  ten  of 
the  tincture  for  children.  Benzole,  rectified, 
used  undiluted  ;  bromine,  three  grains  (TT^.j)  in 
299  minims  of  distilled  water.  Camphor  the 
B.  P.  spirit ;  iodine,  the  B.  P.  vapour ;  iodo- 
form used  pure  ;  creasote  deodorised,  used  un- 
diluted ;  mephitis  putorius  one  in  ten  of  the 
tincture  ;  musk,  one  in  ten  of  the  tincture ; 
phenol  absolute,  ten  grains  to  one  ounce  of  boil- 
ing water.  Oleum  pini,  all  the  pine  oils,  includ- 
ing terebene,  also  eucalyptus,  used  pure ;  soda 
chlorata  the  B.  P.  liquor  ;  sponge  should  not  be 
used  in  an  inhaler.  || 

*  Lancet,  May  14th,  1881,  p.  775. 

+  British  Medical  Journal,  July  23rd,  1881,  p.  120. 

X  British  Medical  Journal,  July  16,  p.  81. 

II  Braithwaite.     Part  Ixxxv.    July.  p.  282. 


ETHER   V8.    CHLOROFORM. 

This  case  is  still  before  the  courts.  Until  the 
ardent  chloroformist  has,  to  use  a  Western  ex- 
pression, "  killed  his  man "  he  will  refuse  to 
see  the  danger  of  using  this  treacherous 
anaesthetic. 

I  would  suggest  to  the  practitioner,  "  who 
has  used  it  hundreds  of  times  and  never  had  any 
trouble  with  it,"  to  take  the  last  volume  of  the 
Lancet,  January  to  June,  18? 2.  He  will  find 
in  that  volume  alone  the  record  of  nine  fatal 
cases  of  chloroform,  and  one  of  ether,  poisoning. 
Of  these  not  one  was  preventible.  Many  other 
deaths  have  occurred  in  that  period  and  have 
been  left  unrecorded,  or  hav6  been  published  in 
other  journals. 

It  is  worthy  of  note,  too,  that  the  proportion 
should  be  9  to  1.  This  is  in  keeping  with  the 
published  statistics.  Chloroform  kills  1  in  2,500, 
ether  1  in  23,204,  or,  in  other  words,  ether  is 
eight  times  safer  than  chloroform. 

The  following  synopsis  of  these  Lancet  cases 
is  instructive. 

DEATHS    FROM    CHLOROFORM. 

1.  A  boy,  aged  9,  Manchester,  chloroform 
given  for  diagnostic  exploration  of  an  abscess. 
Quantity  taken  not  given.  Died  a  few  minutes 
after  administration. 

2.  A  man,  aged  50,  Malvern.  Reduction  of 
shoulder  dislocation.  Two  drachms.  P.  M. 
fatty  degeneration  of  the  heart  and  other  oi-gans 
diseased. 

3.  A  man,  aged  23,  Gloucester.  Excision 
of  eyeball.  Post-mortem  revealed  no  abnormal 
condition. 

4.  A  woman,  Guy's  Hospital.  Setting  a 
fracture.  Heart  examined  before  administra- 
tion. Sudden  death  in  two  minutes.  P.  M. 
fatty  degeneration  of  the  heart. 

5.  Woman,  at  the  Rotunda,  Dublin.  Ovario- 
tomy. 

6.  Woman,  aged  35,  Kensington.  Removal 
of  piles.  Fatty  degeneration  of  the  heart. 
Had  previously  taken  chloroform  for  incision 
of  fistula  in  ano. 

7.  Man,  aged  52,  St.  Bartholomew's  Hospital. 
Cancer  of  lip.  No  indications  of  organic 
disease. 


362 


CANADIAN  JOUKNAL 


8.  Man,  aged  49,  Canterbury  Hospital.  Re- 
moval of  diseased  bone  in  the  foot.  No  indica- 
tions of  organic  disease. 

9.  Man,  27,  London  Surgical  Home,  Fitzroy 
square.  0|>ening  of  lumbar  abscess  by  Prof. 
Lister.     P.  M.  heart  quite  healthy. 

DEATHS    FROM    ETHER. 

1.  Woman,  aged  54,  New  York.  Reduction 
of  a  dislocated  shoulder.  Death  from  conges- 
tion of  the  lungs  two  hours  after  the  opera- 
tion. 

On  this  interesting  subject  two  papers  have 
recently  been  published.  Dr.  Johnson,  in  an 
essay  read  before  the  Medico-Legal  Society  of 
New  York,  notes  the  fact  that  chloroform  acci- 
dents occur,  next  in  frequency  to  those  in  the 
dentist's  chair,  in  operations  about  the  ano- 
genital  region.  These  parts  lose  their  sensibility 
the  last  and  so  profound  anaesthesia  must  be  in- 
duced. Dr.  Johnson  though,i8  wrong  insupposing 
that  the  degree  of  anaesthesia  is  the  dangerous 
element.  Deaths  have  occurred  from  the  very 
smallest  quantity  as  any  one  who  studies  mor- 
tality tables  will  see.  The  following  are  the 
quantities  selected  from  TurnbuU's  work  on 
anaesthetics.  "A  few  drops,"  forty  drops,  fifty 
minims.  M.  Vulpian  recently,  at  the  Paris 
Academic  de  M^Jecine  explains  these  early 
deaths  by  showing  that  if  chlorofurm  be  merely 
applied  to  the  nostrils  of  an  animal,  respiration 
is  sometimes  arrested.  Dr.  Johnson  believes 
the  remnant  of  sensibility  left  in  the  genital 
region  is  the  origin  of  the  charges  brought 
against  practitioners  by  patients  who  have  been 
under  anaesthetics. 

Among  the  medico-legal  points  made  by  the 
essayists  is  one  which  it  would  be  well  for 
hospital  surgeons  to  bear  in  mind.  "  A  surgeon 
allowing  an  untrained  medical  student  to  ad- 
minister anaesthetics,  and  life  being,  therefore, 
lost,  will  subject  the  surgeon  himself  to  a  suit 
for  damages." 

Mr.  Teale  [British  Medical  Journal,  March 
11th)  has  more  than  almost  abandoned  chloro- 
form. The  exceptions  he  makes  in  its  favour 
are  these  :  in  infants,  in  patients  subject  to 
asthma  or  chronic  bronchitis,  and  also,  perhaps 
in  cases  of  abdominal  obstruction,  with  difficult 
breathing  in  which  an  operation  has  to  be  per- 


formed. A  good  "etherist"  can  get  most 
patients  under  the  influence  in  from  one  and  a 
half  to  two  minutes,  whereas  Mr.  Teale  thinks 
chloroform  takes  longer  to  act.  This  is,  perhaps, 
going  a  little  t  o  far.  Ether  in  some  cases, 
according  to  my  experience,  can  produce  insensi- 
bility in  a  very  short  time,  but  in  the  gfmerality, 
the  patient  is  not  anaesthetized  thoroughly 
for  five  to  ten  minutes. 


REPORT  ON  DERMATOLOGY  FOR  THE 

QUARTER  ENDING  SEPTEMBER 

30th,  1880. 

by  j.  e.  graham,  m.d., 

Lecturer  on   Dermatology  and   Adjunct    Lecturer  on 
Medicine,  Toronto  School  of  Medicine  ;  Pathol- 
ogist to  Toronto  General  Hospital. 

Rotheln. — Dr.  Cheadle,  in  an  article  on  this 
subject,  arrives  at  the  fallowing  conclusions  : — 

(1)  That  rotheln  is  a  specific  contagious 
exanthem,  distinct  from  either  measles  or  scar- 
latina. 

(2)  That  the  period  of  incubation  is  from 
eleven  to  twelve  days ;  the  period  of  invasion 
from  two  to  three  days,  but  in  mild  cases  may 
not  be  more  than  twenty-four  hours.  On  these 
points,  however,  more  extended  observations 
are  desirable  for  their  precise  estimation. 

(3)  The  other  features,  which  not  singly,  but 
taken  together  as  a  clinical  proof,  may  serve 
to  distinguish  severe  cases  of  rotheln  from 
severe  cases  of  ordinary  measles,  with  which 
they  are  liable  to  be  confounded  are  : — 

The  slightness  or  absence  of  sneezing  and 
coryza. 

The  greater  severity  and  frequency  of  the 
cough  ;  its  hoarseness  and  laryngeal  character. 

More  marked  catarrh  of  the  larynx  and 
bronchi. 

The  absence  of  intestinal  catarrh,  as  evidenced 
by  absence  of  diarrhoea. 

The  more  papular  character  of  eruption. 

The  ab.sence  of  crescent ic  arrangement,  and 
its  frequently  becoming  confluent. 

Higher  range  of  temperature,  and  its  longer 
persistence. 

Extreme  drowsiness  during  the  eruptive 
stage. 

The  occurrence  of  vomiting  when  the  erup- 
tion approaches  its  maximum. 


OF  MEDICAL  SCIENCE. 


363 


The  occurrence  of  earache  during  its  decline. 
— Archives  of  Dermatology ,  July,  1882, 

Naphtliol. — Prof.  Kaposi  has  made  several 
experiments  with  this  remedy  in  the  treatment 
of  different  diseases  of  the  skin.  It  is  used  in 
the  form  of  a  solution  or  an  ointment.  The 
solution  is  made  as  follows  : — ,10  to  .50  gram,  of 
naphthol  in  100  of  spirit  and  water  ;  from  .15 
to  1  gram,  of  naphthol  to  100  of  ointment. 
An  ung.  naph,  co,  was  also  used.  R  naphthol 
15;  axung.  100;  sapo  vir.  50;  cretae  alb. 
pre.  10 — M, 

The  remedy  seemed  to  be  of  great  value  in 
the  treatment  of  scabies,  psoriasis,  and  prurigo. 

It  is  absorbed  like  tar,  and  separated  by  the 
kilneys  and  bowels.  (I  have  myself  witnessed 
the  rapid  improvement  of  an  obstinate  case  of 
prurigo  in  Prof.  Kaposi's  clinic,  from  the  use 
of  this  remedy.) — Wien.  Med.  Wochenschr, 
Archives  of  Dermatology. 

Iodoform  in  Lupiis. — Dr.  Riehl  has  used  this 
drug  as  a  local  application  with  very  great 
success.  la  order  to  remove  the  epidermis,  a 
fifty  per  cent,  solution  of  caustic  potass  was 
applif  d  after  all  dirt  and  grease  bad  been  re- 
moved by  .soap  and  water.  Left  in  contact 
with  the  skin,  a  caustic  solution  of  this  strengf  h 
in  from  one  to  two  minutes  caused  swelling 
and  transparency  of  the  epidermis.  The  excess 
of  caustic  potass  was  washed  off,  and  a  layer  of 
iodoform  applied,  and  allowed  to  remain  for 
from  five  to  eight  days.  No  suppuration  was 
found  on  removal  of  the  dressings.— Jirc^tves 
of  Dermatology. 

Rick  man  Godlee  recommends  the  following 
formula  :  R  Iodoform  grs.  x,  ol,  eucalypti  3ss., 
vaseline  3  j,  M,  To  be  applied  to  lupus  after 
erasion. 

(This  formula  has  been  found  of  great  use  in 
two  cases  in  my  own  practice.) 

New  Remedy  for  Elephantiasis  Grcecorum,. — 
Dr,  E,  Westland,  acting  on  the  theory  that 
leprosy  is  due  to  a  micro-organism,  has  tried 
salicylate  of  soda,  with  marked  effect  in  three 
cases. 

Dr,  Thin,  of  London,  has  made  a  series  of 
investigations  on  the  habits  and  growth  of  the 
various  parasites  which  infest  the  skin,  and 
reported  the  result  to  the  Royal  Society. 

"  The  conclusions  regarding  trichophyton  ton- 


surans which  are  warranted  by  the  experiments 
recorded  in  the  paper  read  before  the  Royal 
Society  are,  that  it  is  not  one  of  the  common 
fungi,  and  that  it  can  be  cultivated  artificially 
when  moistened  by  vitreous  humour.  When 
it  was  completely  immersed  in  vitreous  humour, 
I  found  no  evidence  of  growth. 

"  So  far  as  we  know,  this  fungus  only  grows 
in  the  epidermic  elements  of  a  limited  number 
of  mammals.  A  careful  consideration  of  the 
views  of  previous  observers,  who  have  described 
it  as  being  simply  one  of  the  common  fungi, 
accidentally  growing  on  the  skin,  has  led  me 
to  the  conclusion  that  these  opinions  are  based 
on  erroneoixs  observations.  In  their  cultivation- 
experiments,  they  had  not  succeeded  ia  exclu- 
ding growths  of  the  spores  of  the  common 
fungi  present  in  the  atmosphere. 

"  The  experiments  which  I  have  tried  are 
pregnant  with  instruction  regarding  the  manage- 
ment of  ringworm.  Cases  of  this  disease  aie 
divisible  into  two  categories.  In  the  first, 
owing  to  the  superficial  position  of  the  spores, 
the  fungus  can  be  destroyed  by  the  application 
of  parasiticide  lotions  and  ointments.  Ir.  the 
second,  owing  to  the  depth  of  the  hair-foll'cle, 
the  spores  are  beyond  the  reach  of  these  appli- 
cations. In  this  latter  class  of  cases,  we  have 
recourse  to  applications  which  provoke  inflam- 
mation ;  that  is  to  say,  to  an  effusion  of 
serum  around  the  follicles.  With  the  thorough 
penetration  of  serum  or  pus  through  the  in- 
ternal root-sheath  and  into  the  fungus  logged 
hair-root,  the  parasite  dies  :  a  clinical  fact  es- 
tablished and  understood  by  all  competent 
observers.  The  limits  of  this  paper  do  not 
permit  me  to  enter  fully  into  the  best  means  of 
provoking  this  curative  inflammation ;  but  I 
desire  to  warn  practitioners  against  placing  too 
much  confidence  in  any  one  kind  or  form  of 
application.  The  age  of  the  child,  the  probable 
depth  of  the  hair-follicle,  and,  above  all,  the 
degree  of  susceptibility  of  the  superficial  blood- 
vessels to  irritation,  must  determine  the  sul)- 
stance  used,  and  especially  the  strength  in 
which  it  is  to  be  employed.  In  all  chrojiic 
cases  of  ringworm,  the  practitioner  must,  in 
the  first  instance,  proceed  cautiously  and  ex- 
perimentally, in  order  to  test  this  susceptibility 
of  the   bkin,    increasing   the    strength   of  his 


364 


CANADIAN  JOURNAL 


remedies  and  the  frequency  of  application  until 
he  has  obtained  a  moderate  but  persistent  con- 
gestion of  the  skin  of  the  affected  patch.  With 
young  children,  this  experimental  process  must 
be  carried  on  with  a  certain  amount  of  caution  ; 
with  older  children,  and  more  especially  with 
boys  over  ten  yeai-s  of  age,  much  time  need 
not  be  lost  in  making  a  very  decided  imjjression. 
In  ringworm  of  the  scalp,  it  is  not  so  much 
the  remedy  that  is  of  importance,  as  the 
judicious  use  of  the  remedy. 

In  ringworm  of  the  body,  t'le  parasite  is  so 
well  within  reach,  that  its  destruction  presents 
no  difficulty.  I  find  one  application  of  tincture 
of  iodine,  and  subsequent  scrubbing  with  soap 
and  water,  sufficient  to  effect  a  cure." 

Dr.  Thin  is  of  opinion  that  in  alopecia 
areata  there  is  a  fungus  which  he  names  the 
bacterium  decalvans.  His  concluding  remarks 
on  this  subject  are  as  follows  : — 

"  It  may  be  well  to  divide  the  statements 
made  in  this  paper  into  two  heads  :  those  which 
relate  to  ascertained  facts,  and  those  which 
relate  to  a  theory  of  the  causation  of  alopecia 
areata,  which,  I  believe,  is  sustained  by  these 
facts. 

"  1.  The  facts  are,  that  minute  bodies  of 
definite  and  fixed  shape  and  size  are  found  in 
and  on  the  hairs  in  alopecia  areata.  Tiiese 
bodies  ai-e  distinct  from  the  granular  elements 
present  in  hairs,  and  are  neither  oily  particles 
nor  crystals.  They  are  of  the  size  and  shape, 
and  have  the  refractive  qualities,  of  bacteria. 
"When  present  in  small  numbers  on  the  shaft, 
the  hair  is  entire ;  whilst  within  some  hairs 
much  affected  by  the  disease  they  were  found 
in  great  numbers. 

"  2.  The  theory  is,  that  these  bodies  are 
bacteria,  and  that  the  disappearance  of  the 
hair  is  due  to  a  breaking  up  of  the  hair-shaft 
by  the  multiplication  in  it  of  the  organisms. 

"  As  I  believe  it  is  desirable  to  give  to  defi- 
nite objects  like  those  which  I  have  described 
a  name  which  will  mark  their  association  with 
the  theory  I  have  founded  on  them,  and  as  I 
Am  myself  satisfied  as  to  their  nature,  I  sug- 
gest the  term  Bacterium  decalvans  as  a  con- 
venient designation."* 

*  Subsequent  recent  investigations  have  confirmed 
the   author's  views  regarding  the  existence    of   this 


Dr.  Thin's  views  on  this  subject  are  opposed 
to  those  of  many  leading  Dermatologists.  The 
latter  consider  alopecia  areata  to  be  the  result 
of  a  trophic  nerve  lesion.  The  whole  paper 
shows  the  great  patience  and  perseverance  of  the 
author  in  pursuing  these  very  delicate  obser- 
vations. It  would  appear  that  the  vegetable 
parasites  which  grow  on  the  skin  are  exc  ed- 
ingly  difficult  to  cultivate,  not  growing  at  all 
in  many  solutions  in  which  the  ordinary  fungi 
sprout  out  most  luxuriantly. 

With  regard  to  the  microsporon  furfur,  the 
parasite  of  pityriasis  rubra,  he  concludes  as 
follows : — 

"The  required  soil  for  the  development  of 
microsporon  is  not  only  the  human  skin  of 
certain  individuals,  but  of  certain  individuals 
within  certain  limits  of  age.  Moist  j)arts  of 
the  skin  of  certain  individuals  during  the 
period  of  sexual  activity  would  seem  to  be  a 
definition  of  this  soil.  Tinea  versicolor  de- 
velops after  puberty,  and  disappears  spon- 
taneously on  the  approach  of  age." 

A.  E..  Robinson,  in  a  contribution  to  the 
histology  of  the  skin  and  sensory  nerves,  read 
before  the  American  Dermatological  Society, 
stated  that  "  the  non-medullated  nerves  form 
plexuses  both  within  the  skin  and  epidermis, 
but  in  neither  situation  did  he  find  the  nerves 
ending  in  free  extremities,  as  is  usually  stated. 
The  majority  of  the  meduUated  nerves  pass 
into  the  papillae  and  form  loops,  the  fibres 
turning  either  into  the  corium,  or  into  the 
neighbouring  papillae. 


TRICHINOSIS. 

W.  H.  AIKINS,  M.D.,  L.R.C.P.,  LOND.,  ETC. 

The  following  is  a  report  of  a  case  of 
trichinosis  which  was  treated  in  Rudolph  Hos- 
pital, Vienna  : — 

The  past  history  is  incomplete,  and,  as  no 
suspicions  were  entertained  that  the  patient 
had  other  than  an  acute  attack  of  rheumatism, 

bacterium.  He  has  now  oliserved  it  in  all  the  phases 
through  which  a  bacterial  organism  may  be  traced,  and 
will  shortly  be  able  to  publish  an  account  of  methods 
by  which  it  can  be  more  readily  observed. — August, 
1882. 


OF  MEDICAL  SCIENCE. 


365 


no  inquiries  were  made  to  ascertain  whether 
diseased  or  uncooked  meat  had  been  eaten. 

Philippena  K.,  aged  19,  occupation  day 
labourer.  Born  in  North  Austria.  Came  to 
Vienna,  Aug.  23rd,  was  admitted  into  the 
hospital  Aug.  28th,  and  died  Sept.  5th. 

Clinical  history:  Aug.  28th. — Patient  has  no 
history  of  any  disease  previous  to  the  present 
attack.  Menses  regular ;  for  past  two  weeks, 
sharp  pains  have  been  felt  in  both  upper  and 
lower  extremities,  constantly  changing  from  one 
part  to  another ;  tongue  coated  ;  in  the  apex  of 
the  right  lung  the  respiratory  sounds  are  weak  ; 
abdominal  wall  tense  ;  stomach  distended  ;  has 
had  diarihoea  since  last  evening ;  left  wrist  and 
knee-joints  swollen;  morning  temp.  100.7;  pulse 
102  ;  evening  temp.  101.8, 

Aug.  31st. — Morning  temp.  99.1  ;  back  of 
left  hand  oeiematous. 

Sept.  1st. — Morning  temp.  99  ;  during  the 
day  has  had  three  fluid  stools  ;  evening  temp. 
103.1. 

Sept.  2ad. — Morning  temp.  99  ;  oedema  on 
dorsum  of  both  feet,  and  lower  extremities  well 
marked  ;  pain  in  small  of  back  and  all  muscles ; 
great  difficulty  in  swallowing;  tenderness  in 
jaws  ;  uvula  red  and  somewhat  (edematous ; 
evening  temp.  102.3. 

Sept.  3rd.  —  Morning  temp.  102 ;  voice 
hoarse  ;  passes  urine  continually  in  bed  ;  pain 
continues  in  muscles  while  the  pain  in  the 
joints  is  not  so  severe  ;  evening  temp.  101.6. 

Sept.  4th — Morning  temp.  99.1  ;  pulse  110; 
slight  oedema  on  upper  right  eyelid ;  great 
oedema  in  back,  over  the  region  of  kidneys  ; 
no  albumen  in  the  urine  ;  pain  in  muscles  much 
less  marked ;  patient  complains  greatly  when 
the  knee-joints  are  moved;  profuse  perspirations 
during  the  day  ;  slight  diarrhoea  ;  spleen  not 
enlarged. 

Sept.  5th. — Temp.  101.2  ;  oedema  is  much 
greater.  11  a.m. — Both  elbow  joints  strongly 
flexed  ;  extension  of  arms  is  all  but  impossible  j 
from  the  vagina  there  is  a  slight  muco-purulent 
discharge  ;  patient  is  very  weak  ;  respiratory 
sounds  rough;  mind  wandering.  Died  at  2.45 
p.m. 

Clinical  diagnosis  :  Acute  rheumatism. 

Treatment:  Quinine  and  salicylate  of  soda. 

Post-mortem :     Body  small,  slightly   built  ; 


rigor  mortis  well  marked  ;  great  oedema  of  ex- 
tremities, not  so  well  marked  in  the  body ; 
dependent  parts  of  a  deep  purple  colour ; 
meninges  and  brain  pale  ;  a  quantity  of  slimy 
fluid  in  the  trachea  and  air  passages ;  the 
mucous  membrane  of  the  larynx,  trachea,  and 
pharynx  injected  and  ecchymosed  ;  lungs  con- 
gested and  oedematous ;  in  the  pericardium 
about  150  c.  c.  of  clear  serum,  and  double  that 
quantity  in  the  peritoneal  cavity  ;  liver  fatty  ; 
gall  bladder  full  of  dark-coloured  bile  ;  kidneys 
showed  evidence  of  previous  disease,  their  cap- 
sules were  strongly  adherent  ;  in  the  bladder 
there  was  some  high-coloured  urine,  its  mucous 
membrane  showed  many  spots  of  ecchymosis  ; 
the  labia  minora  swollen  and  abraded ;  on  the 
abraded  surface  there  was  a  quantity  of  green- 
ish-coloured pus ;  stomach  and  bowels  distended, 
their  mucous  surface  swollen  ;  in  the  elbow  and 
knee-joints  a  large  quantity  of  synovial  fluid. 

There  was  nothing  so  far  observed  to  account 
for  the  clinical  symptoms,  so  the  muscular 
tissues  were  examined  microscopically  and  found 
to  be  packed  with  trichinae,  which  were  still 
living.  When  a  small  portion  of  muscle  was 
treated  with  a  solution  of  caustic  potash,  and 
mounted  in  glycerine,  the  trichinse  were  ob- 
served to  move  slowly,  uncoiling  and  recoiling 
themselves.  In  all  the  muscles  I  examined, 
with  the  exception  of  the  heart,  they  were 
present  in  large  numbers;  none  were  encap- 
suled.  In  stained  sections,  around  the  parasite 
there  was  seen  to  be  an  inflammatory  infiltra- 
tion of  small  cells.  I  examined  also  scrapings 
from  the  mucous  surface  of  the  intestines,  and 
found  many  of  the  parent  parasites. 

Since  the  post-mortem  it  was  ascertained  that 
the  deceased  had  not  eaten  any  preparation  of 
pork  during  the  past  year,  but  that  her  meat 
diet  was  confined  exclusively  to  horse-flesh  and 
underdone  liver. 


M,  Hillairet,  one  of  the  most  distinguished 
members  of  the  Paris  Academy  of  Medicine  in 
the  Section  of  Public  Hygiene,  and  formerly 
Physician  to  the  Hopital  St.  Louis,  died  sud- 
denly, in  September,  from  the  rupture  of  an 
unsuspected  aneurism.  His  age  was  sixty- 
seven  years. 


366 


CANADIAN  JOURNAL 


CASE  OF  DISLOCATION  OF  THE  HIP. 

BY  JOHN  L.  BRAY,  M.D. 
President  Ontario  Medical  Council,  etc.,  ChcUhavi. 

On  Saturday,  the  7th  Sept.,  I  was  called  to 
Louisville  Switch,  about  nine  miles  distant  on 
the  G.  W.  Railway,  to  see  a  man  who  had  just 
been  run  over  by  a  hand  car,  containing  eight 
men.  Dr.  Tye  accompanied  me,  and,  on  arrival, 
we  found  a  man  named  G.  Bapel,  about  45, 
strong  and  very  muscular,  lying  on  a  lounge, 
moaning  greatly,  and  cjmplainiug  of  intense 
pain  in  the  left  hip.  He  also  was  bruised  over 
almost  every  part  of  his  body  and  extremiiies. 
On  examination  under  chloroform  (for  he  would 
not  allow  of  it  without),  we  found  the  left 
femur  dislocated  upwards  and  backwards.  The 
signs  were  well  marked  :  knee  rotated  inwards ; 
leg  flexed,  shortening  of  about  two  inches; 
and  the  tendons  of  the  biceps  femoris,  semi-ten- 
dinosuF,  and  semi-membranosus  muscles  on  the 
stretch.  After  he  was  thoroughly  under  the 
influence  of  the  anJEsthttic,  which  was  admin- 
istered by  Dr.  Tye,  I  thought  I  would  try 
what  manipulation  would  do,  and  was  much 
gratified  with  the  resulf,  for  in  less  than  five 
minutes  I  had  the  satibfuction  to  find  the  head 
of  the  bone  iu  close  proximity  to  the  socket, 
and  then,  by  elevating  the  head  a  little,  it  im- 
mediately returned  to  its  place  with  an  audible 
snap.  I  do  not  report  this  case  as  anything 
new,  but  to  show  that  in  recent  dislocations  of 
the  femur  (no  matter  how  unpromising  they 
may  appear),  how  much  better  it  is  to  reduce 
them  by  manipulation — when  it  can  be  done — 
than  to  do  so  by  means  of  extension,  either 
with  or  without  the  pulleys — for  the  ligaments 
about  the  joint  are  always  more  or  less  lacerated 
— and  forcible  extension,  no  matter  how  ap- 
plied, does  not  tend  to  improve  their  condition 
in  this  respect 

This  was  the  fourth  dislocation  of  the  hip  I 
have  had,  and  the  only  une  I  succeeded  in  re- 
ducing by  manipulation,  although  it  was  tried 
in  the  other  three  cases ;  and  I  am  persuaded 
that  the  chief  reason  why  I  failed  was,  that  the 
patients  were  not  thoroughly  anaesthetised,  and 
although  Hamilton  says  there  is  more  chance 
of  reducing  this  dislocation  by  manipulation, 
without  an  anaesthetic,  as  certain  sets  of  mus- 


cles aid  in  the  return  of  the  bone,  which  force 
is  lost  when  chloroform  or  ether  is  given.  Still, 
I  cannot  agree  with  him,  for  if  one  set  of  mus- 
cles assist  iu  replacing  the  femur,  another  and 
a  btronger  set  of  muscles  antagonize  their 
efforts,  and  it  is  only  when  the  whole  muscular 
power  is  lost  that  this  difficult  dislocation  can 
be  reduced  with  comparative  ease. 

FATTY  DEGENERATION  OF  THE 
LIVER. 

MM.  Lupine  and  Eymonnet  in  the  Lyon 
Medical  note  the  fact  that  the  diagnosis 
of  fatty  degeneration  of  the  liver  is  surrounded 
with  great  difficulties.  The  local  physical  signs 
being  equivocal  and  defective,  the  increase  of 
volume,  the  form  ani  consistence  of  the  or- 
gan having  nothing  characteristic,  Verneuil's 
sign,  general  dropsy  and  diarrhcea,  having  no 
decisive  signification,  and  the  dosage  of  the 
biliary  sulphur  of  the  urine  being  only  indica- 
tive of  diminution  of  the  activity  of  the  liver, 
they  bring  forward  a  new  element  to  assibt  in  the 
diagnosis.  This  new  element  is  taken  from  the 
dosage  of  phosphogly  eerie  acid  contained  in 
the  urine.  Their  method  is  as  follows  :  Remove 
all  the  phosphoric  acid  by  the  magnesian  fluid 
or  baryta  water,  filter  and  evaporate  to  dryness, 
calcine  the  residue  with  nitrate  of  potash,  dis- 
solve this  in  a  little  water  acidulated  with 
nitric  acid,  this  solution  treated  with  magnesian 
fluid  will  show  the  presence  of  phosphoric  acid 
anew.  This  phosphoric  acid  proceeds  from  the 
destruction  during  calcination  of  the  phospho' 
glyceric  acid  contained  normally  in  the  urine, 
as  an  integral  part  of  lecithine.  In  the  normal 
state  the  quantity  of  phosphogly  eerie  acid  con- 
tained in  a  litre  of  urine  is  very  small — com- 
pared with  the  urea,  about  1 -200th  part.  This 
proportion  in  fatty  degeneration  of  the  liver 
may  b«  quintupled  or  decupled,  which  happens 
in  no  other  physiological  or  morbid  condition 
known  up  to  the  ju-epprt. 

Professors  DasLio  aud  Morat  have  punted 
out  that  the  fat  of  the  liver  contains  lecithine. 
MM.  Lupine  and  Eymonnet  have  verified  this 
by  the  direct  analysis  of  fatty  livers,  and  have 


OF  MEDICAL  SCIENCE. 


367 


found  the  fresh  liver  substance  (^atty)  to 
contain  3  %  of  lecithine  and  more  than  15  % 
in  a  dry  liver. 

BACTERIA  OF  SYPHILIS. 
MM.  Martineau  and  Hamonic  have  found 
the  bacteria  of  syphilis,  and  have  succeeded  in 
inoculating  a  pig  with  syphilis  from  the  culture 
liquid.  The  bacteria  are  thus  described,  they 
are  rod-shaped,  of  variable  length  but  not  sur- 
passing in  length  the  diameter  of  a  blood 
globule,  formed  of  a  clear  matter  and  contain 
no  trace  of  a  nucleus,  envelope  nor  granulations. 
They  are  grouped  by  twos  or  are  single  or  are 
joined  end  to  end  and  two  by  two,  but  between 
the  conjoined  bacteria  there  is  a  small  clear 
ppace  so  that  properly  speaking  they  are  not  in 
contact.  Some  are  joined  so  as  to  form  more 
or  less  an  open  angle,  and  sometimes  three  by 
three.  They  offer  divers  movements  around  a 
central  axis  like  a  compass  needle,  some 
pirouette  around  a  transverse  axis,  others 
around  one  of  their  extremities  which  appears 
fixed,  others  have  an  undulatory  or  serpent-like 
movement.  Numerous  other  bacteria  of  varying 
sizes,  forms,  and  movements  were  seen. 

These  bacteria  above  described  were  obtained 
by  immersing  an  excised  indurated  chancre  in 
a  flask  containing  Pasteur's  culture  fluid.  The 
liquor  lost  its  transparency  in  three  hours,  in 
six  a  small  grey  deposit  had  formed  and 
in  twenty-four  hours,  the  bacteria  were  found 
and  inoculated  into  a  young  pig,  in  whose  blood 
the  next  day  were  found  analogous  bacteria.  A 
control  experiment  was  made  by  inoculating  a 
second  pig  with  serum  from  an  infecting 
chancre  and  four  days  after  bacteria  analoeous 
to  those  of  the  first  experiment  were  found  in 
the  blood,  and  shortly  afterwards  papular 
syphilides  appeared,  persisted  for  many  days 
and  finally  dif^ appeared  two  months  after  the 
experiment. — L' Union  Medicate. 


Signer  Maudelin  afiirms  that  the  violets 
V.  syrtica,  v,  tricolor,  and  v.  arvensis  contain 
from  0.083  to  0.144  per  cent,  of  salicylic  acid 
The  other  species  contain  none.  The  wild 
violet  has  much  more  than  the  tricolour.  It  is 
the  action  of  salicylic  acid  that  explains  the  use 
of  the  violet  in  pharmacy. — Nature. 


CONTAGIOUSNESS  OF  CONSUMPTION. 

The  conclusioiis  of  a  paper  on  this  subject, 
read  at  the  laKt  meeting  of  the  British  Medical 
Association,  by  Dr.  C.  Theodore  Williams, 
Physician  to  the  Hospital  for^Consumptives, 
Brompton,  are  as  follows  : — 

1.  The  evidence  of  large  institutions  for  the 
treatment  of  consumption,  such  as  the  Bromp- 
ton Hospital,  diiectly  negatives  any  idea  of 
consumption  being  a  distinctly  infective  disease, 
like  a  zymotic  fever. 

2.  Phthisis  is  not,  in  the  ordinary  sense  of 
the  word,  an  infectious  disease  ;  the  oppor- 
tunities for  Contagion  being  most  numerous, 
while  the  examples  of  its  action  are  exceedingly 
rare. 

3;  In  rare  instances  of  contagion  through 
inhalation,  the  conditions  appear  to  have  been  : 
(1)  Close  intimacy  with  the  patient,  such  as 
sleeping  in  the  same  room  ;  (2)  activity  of  the 
tubercular  process,  either  in  the  way  of  tuber- 
culosis or  evacuation  ;  (3)  neglect  of  proper 
ventilation  of  the  room. 

4.  In  addition  to  the  above,  a  husband  may^ 
though  he  rarely  does  so,  infect  his  wife  by 
coition ;  and  this  risk  is  considerably  increased 
in  the  event  of  pregnancy. 

5.  By  the  adoption  of  proper  hygienic 
measures,  such  as  good  ventilation,  and  separa- 
tion of  consumptive  from  healthy  people  at 
night,  all  danger  of  infection  can  easily  be 
obviated. 

In  a  paper  rt  ad  on  the  same  occasion  by 
Dr.  Robert  Robinson,  Resident  Medical  Ofiicer 
to  the  National  Hospital  for  Consumption, Vent- 
nor,  the  following  conclusions  are  I'eached  : —  . 

1.  Among  100  individuals  affected,  about 
one-third  have  recognizably  been  exposed  to  the 
disease  within  a  period  having  an  appreciable 
connection  with  the  outset  of  their  own  illness. 

2.  Among  married  couples,  of  which  one 
person  has  been  affected,  there  has  been  im- 
munity from  the  disease  in  the  other  person  in, 
at  least,  80  percent,  of  those  inquired  into;  and 
that,  among  the  children  in  the  families  repre- 
sented by  patients  under  observation,  immunity 
from  the  disease  occurred  in  nearly  69  per  cent. 

3.  The  existence  of  phthisis  in  members  of 
the  preceding  genei-ation  was  attended  with  an 
increased   frequency  of  its   occurrence  in  the 


368 


CANADIAN  JOURNAL 


succeeding  one,  amounting   to  nearly   13  per 
cent.     Honce  it  may  be  concluded  that :  — 

1.  Probably,  in  every  case  of  phthisis,  the 
incejttion  and  presence  of  a  specific  bacterium 
is  essential  to  the  destructive  process. 

2.  Probably  there  is  a  certain  risk  of  com- 
munication of  the  disease  to  unafiected  persons, 
and,  cceteris  paribus,  the  greater  the  more  inti- 
mate the  association. 

3.  Continued  association  with  a  consumptive 
person  is  probably  not  in  itself  sufficient  to 
originate  the  disea-se  in  any  instance. 

•i.  The  preparation  of  the  lung  tissue  by 
a  chill,  debility,  etc.,  is  probably  as  esseniiil  to 
the  destructive  process  as  the  presence  of  the 
specific  bacterium  itself. — Brit.  Med.  Journal. 


Cardiac  Typhoid. — M.  Bernheim  (of  Nan- 
cy,) read  a  communication  to  the  French 
Association  for  the  advancement  of  science 
upon  the  Cardiac  form  of  Typhoid  Fever. 
The  author  intends  to  designate  by  this 
term,  cases  in  which,  without  notable  organic 
alteration  of  the  heart,  without  pulmon- 
ary complications,  or  others  capable  of  ex- 
plaining the  fact,  the  pulse  becomes  small, 
frequent,  and  depressible,  and  the  patient  suc- 
cumbs to  this  paralytic  acceleration  of  the  heart, 
which  may  be  produced  either  at  the  beginning 
of  the  fever,  with  or  without  concomitant 
nervous  adynamia,  or  at  a  more  or  less  advanced 
period  of  its  evolution.  The  axillary  temper- 
ature may  be  febrile,  but  moderately  so,  it  may 
even  be  normal  or  subnormal.  M.  Bernheim 
considers  this  nervous  asystole  in  typhoid 
fever  to  be  due  to  a  direct  action  of  the  poison 
or  typhic  microbe  on  the  centre  of  cai-diac  in- 
nervation. In  typhoid  fever  the  pulse  is 
usually  slower  than  in  other  pyrexias,  as  though 
the  typhic  poison,  like  digitalis,  had  a  slowing 
action  on  the  pulse.  It  may  be  conceived,  that 
this  poison  becoming  concentrated  in  very 
great  quantity  on  the  cardiac  nervous  centre, 
may  still  act  like  digitalis  in  toxic  doses,  that  is 
may  produce  paralytic  acceleration.  This 
theory,  would  aho  explain  the  fact  noted  by  the 
author,  that  digitalis  in  these  cases  is  not  only 
inefficacious  but  dangerous,  and  that  even  given 
as  a  prophylactic  it  does  not  prevent  the  man- 
ifestation  of  the  cardiac   form.     The  author, 


bases  his  conclusions  on  six  demonstrative  ob- 
servations with  autoijsies.  Sudden  death  in 
certain  cases  of  typhoid  feVer  where  we  meet 
with  no  appreciable  alteration  of  the  heart, 
may  be  due  to  the  sudden  concentration  of  the 
poison  upon  the  cardiac  centre :  this  is  the 
fovdroyante  variety  of  the  cardiac  form. — 
Le  Prog.  Medical. 


Abnormal  Respiration. — M.  Grancher,  in 
a  paper  ujjon  the  value  of  abnormal  respi- 
rations as  an  early  sign  of  ordinary  tuber- 
culosis, concludes,  that  in  view  of  the  ne- 
cessity of  making  as  early  as  possible  the  diag- 
nosis of  tuberculosis,  a  gi-eater  value  must  be 
attached  to  abnormal  respirations  than  is 
usually  done.  When  they  are  localized  to  one 
apex,  especially  to  the  left  apex  and  are  per- 
manent,  these  abnormal  respirations,  not  only 
permit  a  diagnosis  to  be  made,  but,  compel  it  of 
themselves  without  any  modification  of  the 
sound  or  vocal  vibrations,  and  without  any 
adventitious  signs,  as  crepitation  &c.  These 
abnormal  respirations  are,  in  the  order  of  their 
importance  :  rude  and  low  inspiration,  jerky 
respiration,  and  weak  respiration.  The  rude 
and  low  inspiration  has  the  greatest  value,  for 
it  is  the  most  frequent,  and  most  precocious. 
These  conclusions  are  inapplicable  to  patients, 
subjects  of  a  former  pleurisy  or  pneumonia. 
They  have  their  highest  value  in  young  people. 
— La  France  Medicate. 

Coca  Leaves  in  Painful  Affections  of 
THE  Pharynx  and  Larynx. — Macerate  some 
coca  leaves  in  alcohol.  Evaporate  over  a  water 
bath  to  a  syrupy  consistence.  May  be  employed 
by  painting  or  in  a  vapour  (with  one-tenth 
water  added)  in  painful  pharyngitis,  chronic  or 
sub-acute ;  in  painful  laryngeal  phthisis,  in 
certain  convulsive  cjughs,  and  sometimes  suc- 
ceeds in  oesophageal  spasm.  If  for  laryngeal 
applications  use  as  above  ;  if  for  pharyngeal 
applications  add  one  sixth  of  its  weight  of 
neutral  glycerine. — La  Tribune  Medicale — Lyon 
Medical. 


Kaulich  says  that  a  few  drops  of  tinct. 
belladonnae  given  before  the  ingestion  of 
quiniae  sulph.  will  surely  prevent  vomiting. — 
Lyon  Medical. 


OF  MEDICAL  SCIENCE. 


369 


Spontaneous  Rupture  of  the  Spleen — A 
case  of  this  kind  is  reported  by  Dr.  F.  M. 
Calkins,  in  the  Michigan  Medical  News.  It 
occured  during  the  night,  in  a  woman,  aged  45, 
in  her  usual  health,  who  had  suffered  from 
malaria  and  enlargement  of  the  spleen,  which 
was  located  midway  within  the  left  lumbar  and 
inguinal  spaces.  The  rent  was  in  the  inferior  and 
convex  surface,  and  was  b^  inches  in  length. 
The  spleen  weighed  2lbs  lOoz  ;  and  the  amount 
of  blood  eft'used  was  six  and  a  half  pounds. 


Sea-sickness. — Dr.  Coelho,  Professor  of 
Medicine  in  Rio  de  Janeiro,  was  on  his  way  to 
France  and  suHered  very  much  from  sea- 
sickness. He  tried  all  remedies  likely  to  be 
of  any  use,  but  without  benefit.  At  last  he 
tried  hypodermic  injections  of  morphia,  and 
found  almost  immediate  relief  The  same 
agent  was  used  on  the  other  passengers  and 
with  similar  effect.  Enough  must  be  given 
over  the  stomach  to  produce  sleep. — Wien. 
Med.  Woch. 

The  Regional  Tncidence  op  Hydatid 
Disease. — Dr.  Sigmund  Theodor  Stein,  in  his 
work  on  The  "  Parasitic  Diseases  of  Man,"  gives 
the  following  figures,  compiled  from  Davaine, 
Cobbold,  Fiasen,  and  Neisser  :  Out  of  a  total  of 
1862  cases,  the  liver  was  the  seat  of  the  para- 
sites in  953,  intestinal  tract  in  163,  lungs  and 
pleura  in  153,  kidneys,  bladder,  and  sexual 
organs  in  186,  brain  and  spinal  cord  in  127, 
bones  in  61,  heart  and  blood-vessels  in  61,  and 
other  organs  in  158. 


Buboes. — Dr.  Pavee  reviews  in  the  Wien. 
Med.  Woch.  the  literature  on  the  treatment  of 
buboes,  and  gives  as  the  result  of  his  investi- 
gations and  his  own  experience  in  about  150 
cases,  that  the  best  mode  of  treating  is  to  paint 
the  swelling  twice  a  day  with  tr.  iodi ;  and,  if 
this  does  not  prevent  suppuration,  to  open  the 
bubo  freely  and  deeply,  pass  the  finger  into 
the  wound  along  the  Undermining  channels, 
and  then  fill  the  wound  with  iodoform.  This 
plan  gives  the  best  results,  both  as  to  complete- 
ness of  cure  and  the  time  required.  His  ex- 
perience does  not  corroborate  the  statement 
made  by  some  that  iodoform  is  an  irritating 
dressing  in  venereal  sores. 


THE  CANADIAN 

loiirttiil  of  lykiti  |ricn((, 

A  If  onthly  Journal  of  Medical  Science,  Criticism, 
and  News- 

To  Correspondents. —  We  shall  be  glad  lo  re- 
ceive from  our  friends  everywhere,  curretit  meaical 
news  oj  general  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwarditi^  reports  of  the  proceedings  of  their 
Associations. 

TORONTO,  NOVEMBER,  1882. 

THE   INTERNATIONAL  CONGRESS  OF 
HYGIENE. 

The  Fourth  International  Congress  of  Hy- 
giene was  held  in  Geneva,  under  the  presidency 
of  Dr.  H.  C.  Lombard,  of  that  city,  in  Sej- 
tember  last,  and  is  reported  on  all  hands  as  a 
grand  success.  More  than  400  members  were 
present  representing  some  24  different  nation- 
alities. Our  own  Province  had  the  fortune  to 
be  represented  by  Dr.  C.  W.  Covernton,  of 
this  city,  as  a  member  of  the  Provincial  Board 
of  Health,  and  he  was  selected  to  occupy  the 
chair  of  President  for  Canada.  A  great  deal 
of  work  was  accomplished  in  the  five  sections 
into  which  the  Congress  was  divided,  and  the 
utmost  zeal  and  enthusiasm  were  everywhere 
manifest.  French  was,  of  course,  the  language 
of  the  Congress.  The  lavish  hospitality  of 
both  the  Swiss  Government  and  people  called 
forth  the  loudest  praises  and  gratification  from 
all  who  experienced  it.  Public  and  private 
receptions,  concepts,  binquets,  suppers,  and 
illuminations  were  the  order  of  the  evenings, 
and  on  the  Thursday  the  Mont  Blanc,  the 
finest  steamer  on  Lake  Leman  was  placed  by 
the  Government  at  the  disposal  of  the  Con- 
gress, 350  of  whose  members  embarked  upon 
her  and  were  carried  along  the  southern  shore 
to  Evian-les-Bains,  where  a  sumptuous  luncheon 
was  provided.  On  re-embarkation  the  Italian 
members  insisted  upon  holding  a  meeting  to 
express  the  views  of  the  Congress  in  favour  of 
cremation.  This  was  conducted  in  the  princi- 
pal cabin,  while  th-.se  who  had  no  taste  for 
this  gloomy  subject  enjoyed  the  music  of  the 
band  upon  the  deck,  and  the  unrivalled  scenery 


370 


CANADIAN  JOUHNAL 


of   the   environment.      After   a   visit   to   the 
embouclmre    of  the   Rhone,  and   the   famous 
Castle  of  Chillon,  a  landing  was  made  at  Mon- 
treux,  amid  a  salute  of  20  guns.    At  theKursartl 
a  grand  banquet  was  partaken  ofl'  enlivened  by 
the  music  of  several  bands,  and   the  songs  of 
glee  clubs  occupying  the  stage.     At  this  dinner 
members  of  the  Swiss  Government,  the  Federal 
Council,  and  Local  Administration   were  con- 
spicuoTia.     At  its  conclusion  the  veil  of  night 
was  found  to  have  fallen,  and  the  banqueters 
were  surprised  to  see  the  whole  coast  illumin- 
ated in  their  honour.     Then  followed  a  never- 
to-be-forgotten  sceno,  a  description  of  which  we 
give  in  the  words  of  an  eye-witness,  the  corres- 
pon'^ent  of  the  London  Lancet :    "  Tlie  steamer 
was  gaily  bedecked  with  garlands  of  lamps  of 
many  colours,  while  on  the  fstill  waters  smaller 
craft   flitted  here   and   there,  burning   Bengal 
fire  or  carrying  numerous  lamps  that  reflected 
their  colours   in  the    trans])arent    lake.       The 
Congress  once  on  board,  the  steamer  put  ofl"  a 
little   distance  from  the  pier,  and    then   com- 
menced a  display  of  fireworks,  starting  simul- 
taneously from  the  gardens  of  the  hotels  that 
line  the  shore,  and  from  points  high  up  in  the 
mountains.     Against  the  dark  background  of 
the    mountains,  the    Bengal   fire    enabled    us 
clearly  to  discern  the  elegant  hotels  and  villas 
poised  some  3,000  feet,  above  us  at  Les  Avants 
and  at  Glion.     The  church  steeple  of  Montreux 
was  brightly  lit.     Vevey  and  the  surrounding 
villages  joined  in  the  festivities.     For  some  two 
or  three  miles  along  the  coast  it  was  one  blaze 
of  light,  and  rocket  after  rocket  shot  up  to- 
wards the  sky  ;  while  the  roar  of  cannon,  the 
stirring   strains    of  the   British  National  An- 
them (played  by  a  powerful    brass  band)  the 
cheers  from  the  ship,  and  the  shouts  from  the 
shore,  all  helped  to  conclude  a  reception  uns\ir- 
passed  for  its  cordiality,  and  which    will  for- 
ever remain  deeply  impressed  in  the  memory 
of  the  guests." 

Dr.  W.  H.  Johnson  is  practising  in  New 
Albuquerque,  New  Mexico  ;  Dr.  W.  H.  Oli- 
phant,  in  Redwood,  N.Y.  ;  Dr.  G.  W.  Clen- 
denan  in  New  Durham,  Ont.  ;  Dr.  W.  H. 
Montague  at  Dunnville,  Ont. ;  Dr.  W.  F. 
Eastwoixl,  at  Zephyr,  Out.  Dr.  G.  S.  Bingham 
has  removed  to  Hamilton. 


THE  PROVINCIAL  BOARD  OF  HEALTH 
FROM  AN  ENGLISH  STANDPOINT. 
The  Lomhn  Lancet  of  the  2nd  September 
devotes     a     leader     to     our     newly    created 
Piovincial  Board   of    Health,    and    comments 
in  the  most  approving  terms  upon  the  general 
[jrovisions    of   our  Ontario    Act,  even  going 
so  far  as  to  acknowledge  that  in  some  resp-  cts, 
notably  the  compulsory  powers  of  isolation,  in 
the  public  rather  than  the  individual  interest, 
we  are  much  in  advance  of  English  legislation. 
On  the  subject  of  the  notification  of  infectious 
diseases,  and  of  the  contribution  of  weekly  health 
reports,    without    fee,  however,    the   following 
remarks  are  made  :  "  We  are  bound  to  confess 
that  in  this  respect  the  Board  is  expecting  too 
much  of  the  medical  profession.     That  the  in- 
formation asked  for  is  wanted  in  the  interests 
of  public  health   we  do  not  for  one  moment 
doubt ;    indeed    the   lack  of    proper    sickness 
returns   is    now   universally   recognized   as  a 
serious    want    in     connection    with    sanitary 
administration.     But  a  public  want  should  be 
met  out  of   the  public  funds,  and  it  is  clearly 
unreasonable  to  ask  that  members  of  a  busy  pro- 
fession should,  at  the  sacritice  of  much  valuable 
time,  and  without  any  fee  or  reward,  supply  a 
public  body  with  information   which  will  need 
to  be  carefully  compiled."      This  is  the    view 
we  have  held  and   uttered  from  the   first,  and 
we  are  glad  of  this  opportunity  to  reiterate  it 
once  moro,  thus  strongly  corroborated  by  the 
chief  mouthpiece  of  professional  opinion  in  the 
Motherland.     In  referring  to   Dr.  Covernlon's 
visit  to  England,  and  to  his   being  deputed  to 
attend  the  International  Congress  of  Hygiene, 
in   his   official    capacity    as  a  member  of  the 
Board,  and  to  bring  back  with  him  a  store  of 
information  gathered  from    the    experience  of 
the  "older  established  State  Boards  of  Health" 
of  Europe,  the  Lancet  adds,  "  It  would  be  well 
if  our  own  Central  Health  authority  were  in 
this  respect  to  follow  in  the  wake  of  the  new 
Canadian  Board." 


Prof.  Arnold,  Director  of  the  Berlin  Insti- 
tute for  the  Blind,  has  succeeded  in  teaching 
Stenography  to  his  blind  pupils.  He  says 
they  learn  it  more  readily  than  the  ordinary 
method  of  writing. 


OF  MEDICAL  SCIENCE. 


371 


TORONrO  GENERAL  HOSPITAL. 

A  handsome  and  commodious  building  is 
now  in  process  of  erection  at  the  northern  part 
of  the  General  Hospital  grounds.  It  will  have 
t  wo  storeys,  each  of  which  will  be  divided  into 
two  large  rooms,  a  large  verandah  facing  the 
south,  and  a  conservatory  on  the  west  side  (the 
latter  being  specially  demanded  by  one  of  the 
contributors).  It  will  furnish  day-rooms  for 
the  convalescent  patients,  and  will  no  doubt 
prove  a  great  boon  in  various  ways,  which 
must  be  evident  to  all. 

Dr.  O'Reilly,  the  energetic  Superintendent, 
has  been  anxious  for  years  to  have  such  an 
addition  made  to  his  well-ordered  Hospital, 
and  through  his  representations  some  of  our 
private  citizens  have  generously  supplied  the 
required  funds.  We  are  not  at  liberty  now  to 
give  full  particulars,  but  it  is  probably  no  secret 
that  Mr.  Wm.  Gooderham  has  very  materially 
aided  in  this  good  work.  It  should  not  be  for- 
gotten, while  we  point  with  pride  to  the  num- 
erous charitable  institutions  of  Toronto  sup- 
ported, or  largely  aided,  by  private  contribu- 
tions, that  over  twenty  thousand  dollars  have 
been  given  within  a  few  years  by  private  indi- 
viduals to  our  General  Hospital. 


OPENING  OF  THE  MEDICAL  SCHOOLS. 

The  two  schools  of  this  city — the  Trinity 
Medical  School  and  the  Toronto  School  of 
Medicine— re-opened  on  the  2nd  and  3rd  ult., 
respectively,  the  former  its  12ch,  and  the  latter 
its  40th  session,  both,  we  understand,  with 
unprecedentedly  large  classes.  This  is,  per- 
haps, not  an  unmixed  evil,  nor  a  subject  for 
congratulation  to  anybody  except  the  schools. 
There  is  a  real  danger  of  the  profession  becom- 
ing overstocked,  the  views  of  optimists  to  the 
contrary  notwithstanding.  Some  years  ago  Dr. 
Pepper,  of  Philadelphia,  in  an  introductory 
lecture,  very  clearly  showed  that  in  no  other 
calling  does  so  large  a  proportion  of  those  who 
enter  upon  it  fail  by  the  v^ay,  and  ultimately 
abandon  it  as  incapable  of  realizing  their 
initial  expectations.  A  pretty  full  abstract  of 
Dr.  Barrett's  introductory  lecture  at  the  Tor- 
onto School  of  Medicine  will  be  found  in 
another  column,  as  well  as  a  synopsis  of  Dr. 


Grasett's  address  at  Trinity.  An  accouut  of 
the  Jubilee  Celebration  of  McGill  College  will 
also  be  found  in  the  same  connection. 


A  SAD  OCCURRENCE  AND  SORRY 
SEQUEL. 

It  appears  that  on  the  24th  of  February  last 
one  of  those  melancholy  accidents  which  may 
happen  to  any  one  of  us  at  any  moment,  occur- 
red to  Drs.  Burrows  and  Coulter  in  the  Town 
of  Lindsay.  After  amputation  of  a  toe  under 
the  anaesthetic  influence  of  a  well-recognized 
mixture  of  chloroform  and  ether,  the  patient 
suddenly  succumbed.  All  due  precautions  had 
been  taken,  no  contra-indication  existed,  and 
all  means  of  resuscitation  were  employed,  but 
in  vain.  An  inquest  was  at  once  applied  for 
and  ordered,  but  by  some  unintelligible  inter- 
ference of  the  patient's  friends  was  prevented. 
The  week  following  two  letters  over  noms  de 
plume,  and  defamatory  to  the  Doctors  con- 
cerned in  the  case,  appeared  in  the  Canadian 
Post.  Thereupon  Dr.  Burrows  brought  suit  for 
libel  against  the  proprietor  of  the  Post,  who 
at  once  made  apology  and  divulged  his  corres- 
pondent's name.  An  action  was  then  instituted 
against  the  author  of  the  letters,  Dr.  Herriman, 
of  Lindsay  ;  but  just  before  coming  to  trial,  in 
the  beginning  of  October,  was  amicably  settled, 
Dr.  Herriman  making  a  full  apology  and  recan- 
tation in  the  columns  of  the  Post.  It  does  not 
often  become  our  painful  duty  to  record  so 
disgraceful  an  occurrence  as  the  attempt  on  the 
part  of  one  medical  man  to  defame  the  charac- 
ter and  damage  the  prospects  of  a  brother 
practitioner  by  the  cowardly  expedient  of 
anonymous  communications  in  the  lay  press. 
Still  more  unusual  is  it  to  find  the  melancholy 
occurrence  of  a  death  from  anaesthetic  narcosis 
made  the  text  of  a  brutal  slander,  for  such 
accidents  are  fortunately  rare.  While  sympa- 
thising most  cordially  with  Drs.  Burrows  and 
Coulter  in  the  premises,  we  can  only  express 
our  very  deep  regret  that  Dr.  Herriman  should 
so  far  have  forgotten  what  was  due  to  himself 
as  a  gentleman,  and  co  his  profession  as  an 
honourable,  truth-loving,  and  charitable  fi'Ater- 
nitv,  as  to  have  harboured  such  vindictive 
malice  against  a  fellow  practitioner  and  towns- 
man, and  to  have  stooped  to  such  contemptible 


372 


CANADIAN  JOURNAL 


means  to  give  it  utterance.  Suffice  it  to  say, 
however,  that  he  has  now  done  the  only  thing 
he  could  to  remedy  the  evil  ;  and  we  sincerely 
trust  that  his  conduct  in  the  future  may  prove 
to  Di-s.  Burrows  and  Coulter  a  full  and  hon- 
ourable amend. 


McGiLL  College  and  the  Canada  Medi- 
cal Association. — The  ungenerous  and  unjust 
insinuations  of  the  Canada  Lancet,  in  its  last 
issue,  that  the  members  of  McGill  College,  to 
use  a  pardonable  vulgarism,  were  disposed  to 
and  actually  did  "  run  "  the  Canada  Medical 
Association  to  suit  themselves,  was  calculated, 
and,  perhaps,  intended,  to  excite  the  jealousy  and 
animosity  of  the  Ontario  profession,  and  thus 
damage  the  interests  of  the  Association.  We 
are  pleased,  therefore,  to  find  in  the  Canada 
Medical  and  Surgical  Joumnl,  published  in 
Montreal,  an  editorial  article  repudiating  the 
insinuation,  and  calling  attention  to  the  "  true 
inwardness  "  of  the  suggestion. 

That  our  esteemed  Quebec  contemporary 
may  understand  that  the  spiritual  smallness 
evidenced  by  the  Lancet's  allusion  is  not  parti- 
cipated in  by  the  great  body  of  the  profession, 
in  Ontario,  for  whom  we  profess  to  speak,  we 
would  refer  them  to  our  editorial  remarks  on 
the  subject  atpage  237  of  our  July  issue. 

If  any  cause  for  jealousy  exist  between 
Trinity  Medical  School  and  McGill  College  it 
can  be  of  no  concern  to  the  Canada  Medical 
Association,  and  if  the  Trinity,  or  other  school- 
men are  disposed  on  any  such  trivial  account 
to  hold  themselves  aloof  from  contributing 
what  might  reasonably  be  expected  of  them 
towards  promoting  the  welfare  of  the  Associa- 
tion, so  much  the  worse  for  them.  The  As- 
sociation does  not  owe  its  inception  in  any 
wise  to  their  efforts,  and  it  is  quite  apparent 
that  their  good  or  ill  will  neither  makes  nor 
mars  its  fortunes. 


Honour  to  Whom  Honour  is  Due. — At  the 
late  Jubilee  Celebration  of  the  Medical  Faculty 
of  McGill  University  was  present  one  gentle- 
man, whom  we  still  have  the  happiness  to 
number  among  us,  who  graduated  from  that 
institution  47  years   ago,  Dr    Josei)h   Work- 


man, for  the  last  g**neratiuu  and  up  to  within 
some  four  or  five  years  Medical  Superintendent 
of  the  Asylum  for  the  Insane  at  Toronto  ;  and, 
at  the  meeting  of  the  Medico-Chirurgical 
Society  of  Montreal,  on  the  8th  Oct.,  the  fol- 
lowing resolution  was  passed  in  honour  of  his 
presence  : 

"  That  the  members  of  the  Medico-Chirur- 
gical Society  of  Montreal,  in  session  this  even- 
ing, cannot  allow  the  opportunity  to  pass  of 
expressing  to  you  the  pleasure  your  visit  to 
this  city  has  been  to  them.  They  feel  that  to 
you  the  Medical  Societies  ot  Canada  owe  much. 
Your  zeal  and  ability  have  always  been  liberally 
expended  in  promoting  their  welfare,  and  they 
desire  to  express  the  hope  that  you  may  be  still 
spared  for  many  years  to  give  them  the  Vjenefit 
of  your  wisdom  and  counsel." 

We  are  sure  that  the  profession  of  this  city, 
and  especially  the  members  of  the  Toronto 
Medical  Society,  at  whose  deliberations  he 
for  t\NO  years  presided,  and  the  constant 
sight  of  whose  venerable  form  has  been  an 
encouragement  to  some  and  a  reproach  to 
many,  will  eagerly  join  with  us  in  a  heartfelt 
echo  of  the  sentiments  expressed  above  by  the 
Medico-Chirurgical  Society  of  Montreal. 

Maggots  in  Unusual  Situations. — Dr. 
J.  E.  Prince,  of  Jacksonville,  111.,  narrates  in  the 
Medical  News,  for  Oct.  14th,  a  case  of  ozsena  in 
which  sixty-five  healthy  maggots  had  to  be 
removed  with  forceps  from  the  nares  of  the 
patient,  they  having  resisted  irrigation  and 
other  means  of  dislodgment.  Their  scavenging 
duties,  however,  had  been  well  performed,  the 
discharge  being  freed  from  all  mal-odour.  A 
recent  English  journal  also  contained  notice  of 
a  case  in  which  the  stools  of  the  patient  con- 
tained live  maggots  at  the  time  of  voiding.  A 
lady,  too,  in  this  city,  under  the  care  of  the 
writer,  suffering  from  a  miscarriage,  showed 
him  some  blood  clots,  swarming  with  maggots, 
which,  she  affirmed,  were  present  at  the  time  of 
the  discharge  of  the  clots. 

Mr.  E.  A.  Smith,  274  Yonge  St.,  Toronto,  has 
opened  out  a  large  assortment  of  medical  and 
surgical  instruments.  For  particulars  see  advt. 
in  this  issue. 


OF  MEDICAL  SCIENCE. 


373 


In  proposing  the  toast  "  Prosperity  to  the 
British  Medical  Association,"  at  the  dinner  in 
the  recent  meeting,  Sir  James  Paget  used  the 
following  happy  expression,  "  Do  not  let  our 
disputes  be  very  noisy  on  the  scientific  side. 
Remember  always  that  it  is  only  through  clear 
and  undisturbed  waters  that  you  can  see  what 
lies  at  the  bottom.  In  storms  of  controversy, 
there  is  nothing  to  be  found  but  the  billow 
that  moves  to  mischief,  and  the  foam  that 
disappears." 


The  first  resection  of  the  Stomach  in  Ame- 
lica  was  performed  by  a  Homceopathist,  Dr. 
F.  W.  Koehler,  of  Louisville,  Ky.,  on  the  2nd 
of  Sept.  last,  the  patient  being  a  woman  sixty- 
five  years  of  age.  The  operation  seems  to  have 
been  skilfully  performed  with  all  due  precau- 
tions, except  Listerism  ;  but  the  patient  died 
five  and  a  half  hours  after  its  completion. 

A  new  Antispastic  has  been  discovered  in 
guachamaca  extract  made  from  the  bark  of  the 
Quebracho  plant.  It  corresponds  to  curare  in 
its  properties  and  action  ;  and  not  being  ab- 
sorbed by  mucous  membranes,  must  be  adminis- 
tered hypodermically.  Schiffer,  of  Berlin,  has 
successfully  employed  it  in  tonic  and  clonic 
spasms  of  the  musculature,  in  doses  of  ^th  of  a 
grain. 


The  New  York  Sanitary  Engineer  has  laud- 
ably undertaken  to  print  as  much  as  possible  of 
the  important  information  hitherto  published 
in  the  National  Board  of  Health  Bulletin, 
whose  publication  has  ceased  and  determined 
owing  to  the  niggard  parsimony  of  Congress. 
The  Sanitary  Engineer,  apart  from  its  own 
intrinsic  merits,  deserves  the  support  of  all 
physicians  and  sanitarians  for  its  enterprise  in 
the  premises. 

The  New  Medical  School,  London,  Ont., 
opened  Oct.  2nd  with  a  class  of  fifteen  stu- 
dents. 

Dr.  Stewart,  of  Brucefield,  Ont.,  is  at  present 
in  Vienna,  Austria,  where  he  will  remain  a 
few  months. 


Dr.  Burnet,  one  of  the  Physicians  to  the 
Great  Northern  Hospital,  is  accompanying  the 
Princess  Louise  on  her  Western  tour. 


PERSONAL. 
Dr.  Charles  Morehead,  CLE.,  died  at  Wilton 
Castle,  Redcar,  Yorkshire,  on  the  24th  August, 
in  the  75th  years  of  his  age.  Dr.  Morehead's 
name  is  intimately  associated  with  the  Medical 
history  of  India,  where  he  spent  the  greater 
portion  of  his  professional  life,  and  his  great 
work  had  the  "Diseases  of  India"  for  its  subject. 
An  apt  and  favoured  pupil  of  Alison  and  of 
Louis,  his  diagnostic  powers  and  capacity  for 
clinical  work  brought  no  discredit  to  the  teach- 
ing of  those  two  great  masters.  He  entered 
the  Bombay  Medical  Service  in  1829,  became 
first  Principal  of  the  Grant  Medical  College 
and  Professer  of  Medicine  there  in  1845,  and 
so  continued  until  his  return  from  India  in 
1859.  "Whatever  may  be  the  future  of  the 
Medical  Service  in  India,"  says  the  writer  of 
the  obituary  in  the  London  Lancet,  "  it  has  a 
past  of  which  its  surviving  members  may  well 
be  proud.  In  the  long  list  of  those  who  did 
honour  to  our  profession,  there  are  few  names 
more  deserving  of  fame  than  that  of  Charles 
Morehead." 


Mr.  J.  T.  Clover,  F.R.C.S.,  probably  the 
most  accomplished  practical  administrator  of 
anaesthetics  of  our  time,  is  now  no  more.  He 
was  for  many  years  resident  Medical  Officer  of 
University  College  Hospital,  and  was  a  careful 
and  accomplished  surgeon.  His  name  will 
remain  inseparably  connected  with  the  ap- 
paratuses for  anaesthetic  inhalation,  and  the 
exhausting  detritus  bottle  and  irrigator,  for  use 
in  the  operation  of  lithotrity,  which  he  invented. 


Sir  James  Alderson,  M.D.,  Oxon ,  D.C.L., 
F.R.S ,  for  many  yeai-s  Senior  Physician  to  St. 
Mary's  Hospital,  and  President  of  the  Royal 
College  of  Physicians,  for  three  years  from  1867, 
has  lately  passed  away  at  the  advanced  age 
of  87. 

Dr.  Dorin,  of  Chalons- sur-Marne,  said  to  be 
the  oldest  physician  in  France,  has  just  died  at 
the  age  of  94. 


374 


CANADIAN  JOURNAl- 


Luigi  Concato,  the  celebrated  ProfeBsor  of 
Clinical  Medicine  in  the  University  of  Turin, 
ia  dead. 


It  is  rumoured  that  Oliver  Wendell  Holmes 
is  about  to  resign  the  Professorship  of  An- 
atomy at  Harvard,  which  he  has  held  so  long. 

Prof.  Hildebrandt,  of  Konigsberg,  the  emi- 
nent gynjecologist,  and  author  of  the  treatment 
of  uterine  fibroids  by  the  hypodermic  injection 
of  ergot,  is  dead. 


Drs.  Holland  and  Cottell  resign  the  editorial 
chair  of  the  Louisville  Medical  News,  giving 
place  to  Dre.  L.  P.  Yandell  and  McMurtry. 


??oofe  ^otim. 


Report  on  Some  Anatomical  Variatio7i8  for 
1882.  By  Francis  J.  Shepherd,  M.  D., 
Montreal,  {Reprint  from  Annals  of  Anatomy 
and  Surgery.) 

The  First  Biennial  Report  of  tlie  MicJdgan 
Free  Eye  and  Ear  Ijifirmary.Hy  C.  J.  Lundy, 
A.  M.,  M.  D.,  Surgeon. 


Health  and  Meteorological  Reports  for  the 
State  of  Michigan  for  the  month  of  September. 
By  Henry  B.  Baker,  M.  D.,  Secretary,  State 
Board  of  Health. 


Weekly  Health  Bulletins  issued  by  the  Pro- 
vincial Board  of  Health  of  Ontario.  By  Peter 
H.  Bryce,  M.  a.,  M.  D.,  Secretary. 


The  Journal  of  Cutaneous  and  Venereal  Dis- 
eases. This  is  a  new  candidate  for  professional 
favour  whose  first  appearance  was  made  in 
October.  It  is  edited  by  Henry  G.  Pifiard  and 
Prince  A.  Morrow,  two  well-known  dermatolo- 
gists of  New  York,  under  whose  management 
it  is  sure  to  be  well  conducted.  It  is  issued 
monthly,  at  $2.50  per  annum,  the  publishers 
being  Wm.  Wood  »t  Co. 


Nitro-Glycerine  as  a  Remedy  for  Angiiui  Pec- 
toris. By  Wm.  Murrell,  M.D.,  M.R.C.P. 
Detroit :  George  S.  Davis,  1882. 


This  is  a  small  octavo  of  78  pages,  a  descrip- 
tion of  which  is  best  given  in  its  author's  own 
words,  viz  : — To  give  directions  for  the  admini- 
stration of  nitro-glyceriue  in  angiui  pectoris, 
the  principal  points  buinj;  illustrated  by  refer- 
ence to  cases  under  his  eare,  some  of  which 
were  published  in  the  London  Lancet,  in  1879. 
In  view  of  the  author's  reputation  it  would  be 
superfluous  to  add  a  word  as  to  the  cx"  ■  ution  of 
his  design.  It  appears  from  his  observations 
that  the  eflects  of  nitro-glycerine  in  t\iOAQ  dis- 
tressing cases  are  much  more  lasting  and  satis- 
factory than  those  of  nitrite  of  amyl. 

A  Treatise  on  Diseases  of  the  Eye.     By  Henry 

D.  Noyes,  A.m.,  M.D.,  New  York.     Wm. 

Wood  &  Co.,  27  Great  Jones  St.,  N.Y.,1881. 

(Library  of  Standard  Authors.) 

By  virtue  of  the  ever-increasing  stock  of 
knowledge  in  all  departments  of  medicine, 
works  on  special  subjects  intended  for  the  pro- 
fession at  large  have  necessarily  to  be  at  once 
more  minute  and  more  comprehensive  than 
they  were  formerly.  Even  the  younger  prac- 
titioner, who  has  had  facilities  not  enjoyed  by 
his  older  brother,  ought  to  be  fully  satisfied 
with  the  fund  of  information  on  diseases  of  the 
eye  provided  by  our  author,  whose  work  em- 
bodies the  results  of  much  thought,  extensive 
reading,  and  a  very  large  experience.  More 
need  not  be  said. 


A  Treatise  on  Food  and  Dietetics,  Philosophically 
and  Therapeutically  Considered.  By  F.  W. 
Pavy,  M.D.,  F.RS.,  F.R.C.P.,  Physician  to, 
and  Lecturer  on  Physiology  at  Guy's  Hos- 
pital, etc.  New  York  :  William  Wood  <fe 
Co.     Toronto :   Willing  &,  Williamson. 

In  this  work  (one  of  the  '81  series)  the  dis- 
cussion of  alimentary  principles  and  alimentary 
substances  is  both  comprehensive  and  exhaus- 
tive ;  while  the  second  half,  which  treats  of 
dietetics,  is  more  practical,  and  will  be  read 
with  interest  both  by  physician  and  layman. 
This  distinguished  physiologist  has  long  been 
an  authority  on  this  subject,  and  this  treatise 
is  well  worthy  of  the  author's  reputation.  It 
is  not  only  the  best,  but,  j'crhaps,  the  only  com- 
plete and  systematic  work  of  the  kind  we  have 
access  to,  and  fortunately  it  is  all  that  we  could 
desire. 


OF  MEDICAL  SCIENCE. 


375 


Lectures  on  Ehct'^icity  in  its  Relations  to  Medi- 
cine and  Surgery.  Bv  A.  D.  Rockwell, 
A.M.,  M.D.  New  York  :  Wm.  Wood  <fe  Co. 
Toronto  :  Willing  <fe  Williamson. 

The  second  edition  of  these  lectures  contains 
some  new  matter — notably  a  lecture  upon 
Franklinic  Electricity,  and  a  notice  of  the  "Gal- 
vanic Accumiilator,"  or  storage  battery. 

The  author's  methods  of  general  faradization 
and  central  galvanization  are  clearly  and  care- 
fully explained,  the  indications  for  their  use 
detailed,  and  their  inapplicability  to  all  cases 
admitted.  Caution  is  urged  upon  the  practi- 
tioner in  the  empiric  use  of  electricity.  Pro- 
found study,  close  observation,  and  long  ex- 
perience are  required  for  the  successful  use  of 
this  powerful  therapeutic  agent. 

The  Lectures  wiirdoubtless  prove  beneficial 
to  those  who  may  be  desirous  of  taking  up  the 
study  of  electro-therapeutics,  as  also  to  the 
practitioner  by  giving  useful  hints  in  obstinate 
cases. 

Mental  Pathology  and  Therapeutics.  By  W. 
Griesinger,  M.D.,  Professor  Clinical  Medi- 
cine and  Mental  Science,  in  the  University  of 
Berlin.  Translated  from  the  German  (second 
edition).  By  C.  Lockhart  Robertson,  M.D., 
Cantab.,  and  James  Rutherford,  M.D., 
Edin.  New  York  :  William  Wood,  &  Co., 
1882. 

The  issue  of  Wood's  Library  for  1882, 
contains  this  well-known  work,  reproduced 
from  the  translation  made  by  Drs.  Lockhart 
Robertson,  and  Rutherford  for  the  New  Syden- 
ham Society,  in  1867.  The  first  edition  of  the 
original  having  been  published  in  1845,  and 
the  second,  now  nearly  twenty  years  ago,  it  would 
be  manifestly  unfair  to  institute  a  comparison 
between  it  and  later  works  upon  the  subject. 
The  volume  is  valuable,  however,  as  having 
been  facile  princeps  in  its  time,  and  as  present- 
ing the  views  and  teachings  of  an  ancieni  chief 
in  the  modern  school  of  German  Medical 
Psychology. 


The  Diseases  of  the  Rectum,  including  Fistula, 
Uoemorrhoids,  Painful  Ulcer,  Stricture,  Pro- 
lapsus,  &c.  By  Wm.  Allingham,  M.D., 
F.R.C.S.,  Surgeon  to  St.  Mark's  Hospital 
for  Diseases  of  the  Rectum,  &c.  Philadel- 
phia:  P.  Blakiston,  Son  &  Co.,  1882. 


Dr.  Allingham's  reputation  in  this  specialty 
is  world-wide,  and  this  fourth  edition  of  his 
Treatise  on  this  subject  is,  as  might  be  expected, 
a  most  excellent  one.  The  fruits  of  his  rich 
and  ripe  experience  are  evidenced  on  every 
page.  In  operating  on  internal  hcemorrhoids 
he  expresses  a  decided  preference  for  the  liga- 
ture, combined  with  incision  after  dilatation 
of  the  sphincters,  and  shows  by  reference  to  the 
statistics  of  others,  as  well  as  his  own,  that  it 
is  much  safer  than  the  operation  with  Heary 
Smith's  clamp  and  cautery.  His  treatment  of 
fistula,  ulcer,  stricture,  &c.,  is  souud,  while 
safe,  and  we  can  find  no  place  for  unfavourable 
comments.  When  we  consider  the  price  (75 
cents)  we  must  certainly  feel  surprised,  if  it  is 
not  found  in  the  majority  at  least  of  medical 
libraries. 

Treatment  of  Cancer.  By  John  Clay,  Pro- 
fessor of  Midwifery  in  Queen's  College,  and 
Obstetric  Surgeon  to  the  Queen's  Hospital, 
Birmingham.  London:  J.  <feA.  Churchill,  11 
New  Burlington  street.     Price,  one  shilling. 

In  this  pamphlet  Mr.  Clay  gives  his  original 
paper  on  the  treatment  of  cancer — especially 
cancer  of  the  female  generative  organs — by 
Chian  turpentine,  as  they  appeared  in  the  Lon- 
don Lancet;  and,  while  confirming  the  state- 
ments which  appear  therein,  he  adds  mach  that 
is  interesting  on  improved  methods  of  using  the 
remedy,  together  with  other  important  aids  in 
the  treatment  of  this  formidable  malady. 

The  experience  of  the  majority  who  have 
used  Chian  turpentine  is  rather  disappointing, 
but,  in  the  face  of  the  evidence  adduced  by  this 
distinguished  surgeon,  this  agent  must  not  be 
overlooked  while  we  are  treating  cancer  of  the 
uterus,  and  if  we  decide  to  use  it,  we  should  be 
cai'eful  in  adopting  all  the  precautions  recom- 
mended in  procuring  the  pure  article,  and  giving 
it  a  thoroughly  fair  trial  with  all  the  "aids" our 
author  refers  to. 


A  Practical  Laboratory  Course  in  Medical 
Chemistry.  By  John  C.  Draper,  M.D., 
LL.D.,  Professor  of  Chemistry  in  the  Medi- 
cal Department,  University  of  New  York. 
New  York  :  Wm.  Wood  tk  Co. 

This  is  a  really  admirable  little  work.  With- 
out making  any  of  the  pretensions  of  the  innum- 


376 


CANADIAN  JOURNAL 


erable  short  cuts  to  knowledge  with  which  the 
field  of  medical  educational  literature  is  flooded, 
it  forms  an  exceedingly  handy  and  useful  com- 
pendium for  the  practical  chemistry  room.  The 
volume  is  in  note-book  form,  and  by  a  judicious 
arrangement  of  alternate  blank  leaves,  may  be 
made  to  serve  the  double  purpose  of  text  and 
note-book.  After  a  few  introductory  pages 
devoted  to  instructions  for  manipulation,  it 
proceeds  to  give  the  methods  for  the  detection 
and  treatment  of  the  principal  poisons.  This 
is  followed  by  a  chapter  on  the  examination 
of  water  for  organic  or  inoi'ganic  impurities,  its 
puii6cation,  etc.,  and  a  third  section  deals  with 
animal  fluids,  especial  attention  being  paid  to 
the  subject  of  urinary  analysis.  The  general 
arrangement  of  the  work  cannot  fail  to  recom- 
mend itself  to  the  student. 


Syphilis.  By  Y.  Cornil,  Professor  Faculty 
Medicine  of  Paris,  Physician  to  the  Lourcine 
Hospital.  Translated  with  notes  and  addi- 
tions, by  J.  Henry  C.  Simes,  M.D.,  and 
J.  William  White,  M.D.,  of  the  Univer 
sity  of  Pennsylvania.  With  84  illustrations. 
Philadelphia :  Henry  C.  Lea's  Son  &  Co., 
1882. 

This  work  is  a  re-production,  with  the  addi- 
tion of  much  valuable  matter,  interpolated 
within  brackets  in  the  text  by  the  American 
editors,  of  lectures  delivered  by  Cornil  in 
1878  at  the  Lourcine  Hospital  of  Paris.  The 
author  had  there,  of  course,  unbounded  oppor- 
tunities of  study  and  investigation  ;  and  his 
object  was  to  occupy  a  new  field  and  fill  up  a 
hiatus  in  the  long  list  of  many  valuable  contri- 
butions to  the  literature  of  syphilis  in  his  own 
and  other  languages.  This  he  has  most  success- 
fully accomplished  by  approaching  the  study  of 
syphilitic  lesions  from  the  anatomical  side. 
The  histological  view  of  syphilis  is  therefore 
the  unique  and  vital  feature  of  this  book  ;  but 
clinical  records  of  cases  are  not  wanting.  After 
general  considerations  on  the  disease,  its  inci- 
dence upon  the  various  tissues  and  organs  of 
the  body  is  fully  studied  and  elaborately  illus- 
trated, and  a  concluding  chapter  is  devoted  to 
treatment,  after  the  French  fashion  of  course. 
A  valuable  bibliography  and  a  good  index  com- 
plete the  work.     Standing  apart  as  it  does,  the 


only  one  of  its  kind,  this  work  j)resent8  posi- 
tive excellencies  alone.  There  is  no  room  for 
compatisona,  odious  or  otherwise.  As  the 
original  exhibits  all  the  characteristics  of  a 
master-piece  of  a  master  mind,  so  the  transla- 
tion in  its  English  dress  bears  ample  evidence 
of  the  zeal  and  faithful  imitation  of  true  dis- 
cij)les. 


l^ijSaHaufauis!. 


ABSTRACT  OF   INTRODUCTORY  LEC- 
TURE. 

JfOth  Session,  Toronto  School  of  Medicine, 
October  3rd,  1882. 

BY  M.  BARRBTT,    M.A.,    M.D., 

Lecturer  on  Physiology,  &c. 

Mr.  Chairman  and  Gentlemen, — My  col- 
leagues have  conceded  to  me  the  honour  of  ad- 
dressing you  upon  this,  the  first  meeting  of  the 
Toronto  School  of  Medicine  for  the  iOth  Ses- 
sion, 1882-3. 

In  the  first  place,  therefore,  I  beg  leave  to 
welcome  our  numerous  fiiends  who  honour  us 
with  their  presence  upon  this  momentous  occa- 
sion, and  also  those  of  my  audience  who  in  pre- 
vious sessions  have  occupied  the  seats  of  this 
lecture-room,  and  further  to  say  to  those  gen- 
tlemen who  for  the  first  time  now  present 
themselves  as  students  of  the  Toronto  School 
of  Medicine,  that  as  in  the  past,  so  in  the  pre- 
sent and  future  sessions,  it  will  ever  be  the 
earnest  endeavour  of  each  and  every  lecturer  to 
forward,  by  precept  and  example,  the  best  in- 
terests of  the  medical  student.  To  you  then 
more  particularly,  gentlemen  who  now  for  the 
first  time  are  attending  a  course  of  medical 
lectures,  permit  me  to  ofier  the  following  re- 
marks :  .  .  .  You  by  your  presence 
on  this  occasion  testify  that  you  are  willing  to 
assume  the  charge  of  alleviating,  to  the  best  of 
your  ability,  those  ills  of  the  flesh  to  which 
God's  ci-eatures  are  liable — ills  arising  in  no 
case  from  the  imperfection  of  an  all-wise  Ma- 
ker's hand,  but  from  man's  violation  of  His 
divine  laws.  A  violation  not  to  be  clearly 
traced,  perhaps,  in  every  case,  yet  in  the  large 
majority  so  manifest  that  we  may  safely  infer 
that  every  ill  that  flesh  is  heir  to,  is  but  the 


OF  MEDICAL  SCIENCE. 


377 


merciful  punishment  due  to  the  infringement 
of  His  divine  laws.  In  preparing  yourselves 
to  assume  this  sacivd  duty  you  are  prompted, 
it  is  to  be  hoped,  by  no  mercenary  motives  : 
the  love  of  your  fellow  man,  your  s^/mpathy 
with  suffering  humanity,  must  be  the  main- 
springs of  your  contemplated  devotion  to  the 
study  of  medicine  ;  but  your  best  emotions  aris- 
ing from  natural  instinct  will  not  be  sufficient 
to  carry  you  through  to  the  completion  of  your 
proposed  undertaking.  The  very  exercise  of 
your  profession  will  have  a  tendency  to  render 
you  somewhat  callous  to  human  suffering  un- 
less your  sympathies  be  founded  on  a  broader 
basis  than  mere  instinct — a  basis,  it  is  to  be 
hoped,  established  befoi'e  now,  for  the  atmos- 
phere of  a  Medical  School  is  not,  by  the  out- 
side world,  considered  to  be  the  most  con<;enial 
for  the  development  of  the  greatest  of  the 
Christian  virtues.  Charity. 

Among  the  several  professions  the  introduc- 
tion to  that  of  medicine  probably  presents  the 
greatest  obstacles  ;  independently  of  the  time 
necessarily  given  to  its  study,  and  the  expendi- 
ture of  money  which  such  time  involves,  the 
mental  labour  demanded  is  undoubtedly  greater 
than  that  required  for  any  other  pursuit.     .     . 

To  some  seeking  a  profession,  the  prospect  of 
acquiring  wealth  is  the  all-powertul  temptation. 
No  matter  what  may  be  the  difficulties  sur- 
rounding it,  or  the  liabilities  which  it  may  in- 
volve, if  it  should  have  happened  that  a  few  of 
those  engaged  in  its  pursuit,  have  acquired 
more  than  a  competency,  the  multitude  snatch 
at  the  phantom  only  to  find  their  grasp  eluded. 
Wealth  is  almost  unknown  to  those  in  the 
ranks  of  the  medical  profession,  yet  a  compe- 
tency may  be  reasonably  looked  forward  to 
after  years  of  severe  toil  by  the  industrious 
and  prudent.  Some  again  desirous  of  escaping 
the  laborious  toil  of  the  agriculturist  or  of  the 
handicraftsman,  without  considering  the  ques- 
tion as  to  their  aptitude,  resulting  from  previ- 
ous education  and  social  position,  take  to  the 
study  of  one  of  the  learned  professions,  and  dis- 
appointment is  almost  the  invariable  result. 
When  too  late  they  discover  the  error  of  their 
choice,  more  especially  if  the  profession  they 
may  have  selected  should  happen  to  be  that  of 
medicine ;  for  here  there  is  no  escape  from  toil. 


and  that  the  most  arduous,  both  mental  and 
bodily.  The  man  who  is  afraid  of  excessive 
labour  is  little  suited  for  an  occupation  which 
constantly  requires  its  devotee  to  travel  at  all 
seasons  of  the  year,  exposed  to  the  inclemen- 
cies of  all  weather,  at  all  hours  of  the  day  and 
night,  resisting  the  urgent  demand  for  sleep, 
through,  oftentimes,  the  worst  roads  of  our 
Canadian  back  settlements,  to  visit  the  sick  or 
to  assuage  the  sufferings  of  the  dying.  Such 
an  occupation  is  surely  not  one  of  ease,  and 
compares  most  unfavourably  with  either  that 
of  the  farmer,  the  mechanic,  the  lawyer,  or  the 
divine. 

Has  the  profession  of  medicine  no  allure- 
ments 1  Is  its  difficulty  of  study  and  attain- 
ments such,  its  pursuit  so  full  of  anxiety,  toil, 
and  exposure,  that  even  the  mariner  would  not 
exchange  his  calling  for  it.  and  have  these  noth- 
ing to  counterbalance  them  ]  Yes.  The  practice 
of  medicine  has  its  allurements,  and  they  are 
sufficiently  great  in  the  minds  of  those  worthy 
of  the  profession  to  outweigh  the  difficulties  at- 
tending its  acquisition.  First  of  all,  and  before 
all,  and  above  all,  it  confers  the  privilege  of  re- 
lieving suffering  humanity ;  of  saving  from 
imminent  death  thousands  upon  thousands  of 
those  whose  lives  may  henceforth  justify  the 
hope  of  immortal  happiness.  No  more  fitting 
emblem  of  mercy  can  be  found  than  the  physi- 
cian braving  the  dangers  of  the  pestilence  in 
the  wretched  hovels  of  the  poor,  or  the 
surgeon  upon  the  battle-field,  ministering  alike 
to  friend  or  foe,  without  hope  of  earthly  re- 
ward, but  feeling  amply  recompensed  in  the 
conscientious  discharge  of  his  merciful  calling. 
One  day  of  such  an  opportunitv  to  render  ser- 
vice to  God  and  man  is  worth  a  whole  life  spent 
in  the  acquisition  of  a  science  which  confers 
such  power  upon  its  possessor.  To  relieve  the 
sick  poor  with  medical  aid  is  also  the  favour- 
able occasion  of  the  kind-hearted  physician  :  in 
large  cities  such  as  this,  where  poverty  so 
abounds,  the  demands  made  for  charitable  aid 
upon  the  time  of  the  practitioner  are  fre- 
quently greater  than  his  time  and  means  will 
permit  him  to  accede  to ;  in  such  cases  the 
efforts  of  the  senior  students  of  medicine  are 
gratefully  accepted  by  the  suffering  poor,  and 
thus  many  opportunities  are  presented  for  the 


378 


CANADIAN  JOCJRNAL 


acquisition  of  professional  experience,  and  for 
the  manifestation  of  that  mercy  so  eloquently 
pourtrayed  bj  the  Bard  of  Avon,  and  pecu- 
liarly applicable  to  the  position  of  the  medical 
student — 

"It  is  twice  bless'd  ; 
It  blesseth  him  that  gives  and  bim  that  takes." 
•  •  *  • 

Again,  the  study  of  medicine  possesses  great 
charms  for  the  lover  of  nature?.  No  employ- 
ment can  prove  more  congenial  to  the  mind 
fitted  for  the  admiration  of  God's  works  than 
the  application  of  the  truths  derived  from  en- 
quiry into  Nature's  mysteries  to  the  well-being 
of  the  highest  in  the  scale  of  creation. 

Many  of  the  greatest  discove.nes  made  in 
biological  science  have  resulted  from  the  la- 
bours of  those  members  of  the  profession  who 
have  not  been  the  most  actively  engaged  in 
medical  practice,  but  have  chosen  rather  a  con- 
tinuance of  the  student's  life,  thus  sacrificing 
every  prospect  of  wealth  or  afiiuence  in  order 
to  gratify  their  intense  love  for  a  knowledge  of 
the  wonders  of  nature. 

But  the  profession  of  medicine  is  not  with- 
out its  worldly  advantage  and  that  of  a  high 
order — the  universal  demand  for  the  services 
of  the  physician  and  surgeon  is  such  that,  place 
him  where  you  will,  his  profession  clothes  him 
as  with  an  aegis,  ever  protects  him,  ever  sup- 
ports him.         .... 

Having  thus  briefly  laid  before  you  the  diffi- 
culties and  the  advantages  of  the  medical  pro- 
fession I  proceed  to  sj^ak  of  the  requirements 
necessary  for  those  who  embark  in  the  study 
of  the  healing  art ;  and  first  of  all  must  be 
placed  the  desire  for  knowledge,  for  its  own 
sake,  independently  of  the  honour  and  emolu- 
ment to  spring  from  its  possession. 

The  i)rofe88ion  of  your  choice  demands  for  its 
successful  pursuit  the  utmost  culture  of  all  the 
mental  power  which  the  largest  munificence 
may  have  bestowed.  Ignorance  on  the  part  of 
the  practitioner  is  criminal  and  may  never  be 
pleaded  as  an  excuse  for  malpractice.  The  lives 
of  the  most  valued,  of  the  highest  as  of  the 
lowest  in  worldly  station,  of  the  aged  and  of 
the  young,  of  the  mother  and  of  the  ofispring 
are  henceforth  to  be  confided  to  your  pro- 
fessional skill.     You  may  not  excuse  yourselves 


with  the  trite  saying,  "  I  did  as  well  as  I 
could,"  it  must  be,  "  I  did  as  well  as  could  be 
done."  No  second-rate  order  of  attainment 
can  be  tolerated  in  the  practitioner  of  medi- 
cine ;  when  employed  ever  remember  that  you 
are  so  employed  because  you  are  thought  to 
possess  all  the  professional  qualifications  attain- 
able by  human  being.    . 

The  morals  of  the  physician  are  scarcely 
second  in  importance  to  the  knowledge  he  may 
bring  to  bear  upon  his  profession  ;  the  medical 
practitioner  should  be  a  gentleman  in  the 
widest  sense  of  the  term. 

The  truly  scientific  practice  of  medicine  may 
be  said  to  have  had  its  beginning  in  the  latter 
part  of  the  17th  century,  for  prior  to  the  dis- 
covery of  the  circulation  of  the  blood,  no  basis 
existed  upon  which  to  build  a  knowledge  of 
physiology  and  through  it  the  practice  of  m  di- 
cine  and  sui-gery.  Before  this  time  the  dicta  of 
the  astrologer  and  the  sorcerer  were  accepted 
as  the  chief  guides  to  a  restoration  to  health 
when  departed  from. 

Wm.  Harvey  was  born  at  Folkestone,  in 
England,  and  after  graduating  at  the  Univer- 
sity of  Cambridge  went  to  Padua  and  prose- 
cuted his  anatomical  studies  under  the  direc- 
tion of  Fabricius  d'Acquapendente  ;  he 
returned  to  England  when  24  years  of  age, 
and  shortly  afterwards  received  the  appoint- 
ment of  Professor  of  Anatomy  and  Surgery  at 
the  Royal  College  of  Surgeons.  When  about 
40  years  of  age,  in  1616-1619,  he  made  public 
his  great  discovery  of  the  circulation  of  the 
blood.  The  announcement  was  received  with 
unsparing  ridicule,  and  for  more  than  twenty 
years  provoked  unrelenting  persecution.  The 
inventive  spirit  with  which  nature  had  en- 
dowed Harvey  was  not  wanting  to  many  of 
those  who  before  him  had  engaged  in  the  same 
path,  but  that  which  he  possessed  in  a  higher 
degree,  and  which  enabled  him  to  attain  the 
end,  of  which  his  predecessors  had,  at  the 
most,  been  able  only  to  guess  the  existence,  is 
that  lucid  comprehension,  that  prompt  and 
sound  judgment,  that  exquisite  good  sense 
which  always  guided  him  in  the  appreciation 
of  facts,  in  the  deduction  of  consequences,  and 
in  the  selection  of  proofs  which  he  invoked  to 
set  forth  his  teachings.     Harvey   was  one  of 


OF  MEDICAL  SCIENCE. 


379 


those    choice  intelligences    who,    at    the    first 
glance,  unravel  the  true   from  the  false,  who 
raise  themselves  to  such  a  commanding  point 
of  view  that  they  are  enabled  to  embrace  the 
whole   connection   of  facts,    but   who  love  to  , 
walk   upon   a   solid    foundation,    who    reason  | 
always  with  exactitude,  and   who  can  clearly  | 
express  the  ideas  which  they  have  conceived,  j 

In  Harvey's  own  account  of  his  discovery 
he  says,  "  When  I  began  to  study,  not  in 
books  but  in  nature  and  by  the  help  of  vivisec- 
tions the  movements  of  the  heart,  the  task 
appeared  to  me  so  difficult  that  I  was  almost 
tempted  to  believe  that  God  only  could  under- 
stand them.  But  by  giving  each  day  more 
attention  and  care,  in  multiplying  my  vivisec- 
tions, making  use  of  a  great  variety  of  animals, 
and  collecting  many  observations,  I  believed 
that  I  had  at  length  arrived  at  a  knowledge  of 
the  truth.  Since  then  I  have  not  hesitated  to 
communicate  my  views,  not  only  to  a  few 
friends,  but  in  public  in  my  anatomical 
teachings.  They  have  been  favourably  received 
by  some,  blamed  by  others ;  on  the  one  hand 
the  crime  has  been  imputed  to  me  of  straying 
from  the  precepts  of  my  predecessors  ;  on  the 
other  hand,  a  desire  has  been  expressed  to  see 
me  further  develop  these  novelties  which 
might,  perhaps,  be  worthy  of  attention.  At 
length,  yielding  to  the  counsels  of  my  friends, 
I  decided  upon  making  use  of  the  press  in 
order  to  submit  myself  and  my  labours  to 
public  opinion."  Such  are  Harvey's  expres- 
sions as  to  his  motives  for  the  publication  of 
his  book — he  almost  seeks  to  excuse  himself 
tor  it,  and  nevertheless  it  is  a  masterpiece. 
Not  only  does  it  contain  one  of  the  most  im- 
portant discoveries  in  physiology,  but  it  is 
written  with  such  perfect  method,  that  Roger 
Bacon  perhaps  was  thinking  of  the  researches 
of  his  modest  and  wise  fellow-countryman 
when  he  laid  down  with  a  masterly  hand  the 
rules  to  be  followed  in  scientific  investigations. 

Seven  years  after  the  publication  of  his 
treatise  Harvey  was  appointed  physician  to  the 
unfortunate  King  Charles  I.,  and  ever  re- 
mained faithful  to  his  Sovereign.  As  a  reward 
he  was  chosen  Warden  of  Merton  College, 
Oxford,  in  1645.     When,  however,  the  parlia- 


mentary visitors  came  there,  he  left  Oxford 
for  London  where  he  died  in  1658.  We  are 
not  less  indebted  to  our  illustrious  fellow- 
countryman  who  discovered  the  circulation  of 
the  blood  for  having  paved  the  way  to  a 
rational  treatment  of  aneurismal  and  wounded 
arteries  by  the  modern  operation  of  placing  a 
ligaturft  between  the  heart  and  the  seat  of 
disease  or  injury. 

Although  England  has  produced  many  dis- 
tinguished anatomists,  Dr.  Wm.  Hunter  un- 
doubtedly occupies  the  first  rank  ;  he  was  born 
in  1718,  in  Lanarkshire,  and  went  to  London 
in  1741.  Dr.  Wm.  Hunter  not  only  gave  a 
new  impulse  to  anatomical  science,  the  effects 
of  which  have  been  transmitted  to  the  present 
time,  but  his  zeal  in  behalf  of  his  favourite 
pursuit  tended  to  make  many  converts. 
Among  these  the  celebrated  John  Hunter 
stands  foremost.  Hearing  of  his  brother's 
reputation  he  offered  his  services  as  an  assist- 
ant, and  his  proposal  was  kindly  accepted. 
The  active  mind  of  John  Hunter,  guided  by  a 
deep  insight  into  the  powers  of  the  animal 
economy,  substituted  for  a  dangerous  a  ad 
unscientific  operation,  an  improvement  formdod 
upon  a  knowledge  of  those  laws,  first  revealed 
by  Harvey,  which  influence  the  circulating 
fluids  and  absorbent  system  ;  the  first  opera- 
tion was  performed  by  John  Hunter,  in 
December,  1785,  in  a  case  of  popliteal  aneur- 
ism, in  which  the  femoral  artery  was  ligatured, 
and  since  that  time  this  mode  of  treatment 
was  universally  employed  by  surgeons,  until 
the  introduction  of  compression  in  1842.  The 
result  of  the  united  labours  of  the  two  brothers 
was  the  formation  of  a  museum  of  comparative 
anatomy  ;  this  museum  was  bequeathed  under 
certain  conditions,  which  have  been  most  faith- 
fully fulfilled  to  the  Royal  College  of  Surgeons 
in  London.  Dr.  John  Hunter  died  in  1793. 
Passing  down  the  stream  of  time  we  meet 
with  the  wonderful  discovery  of  the  effects  of 
vaccination  ;  it  is  to  be  observed  that  the  prac- 
tice of  inoculation,  meaning  thereby  the  intro- 
duction of  the  actual  virus  of  small-pox,  had 
been  in  vogue  throughout  China  and  the  East* 
generally  from  a  very  early  period  in  the 
world's  history.  This  practice  was  introduced 
into  Great  Britain  by  a  very  celebrated  Eng- 


380 


CANADIAN  JOURNAL 


lish  woman,  Lady  Alary  Wortley  Moutagu, 
wife  of  the  British  Ambassador  at  the  Court  of 
the  Ottoman  Empire. 

The  daughter  of  Lady  Wortley  was  the  tirst 
person  inoculated  in  England,  thus  recom- 
mending the  pmctice  by  her  own  example.  To 
this  noble  and  patriotic  women,  then,  the  pro- 
fession and  the  public  ai-e  indebted  for  that 
preliminary  knowledge  which  led  up,  after 
eighty  years,  to  the  great  discovery  made  by 
..'enner  in  1798 — its  birthday  being  usually  as- 
signed to  the  14th  of  May,  1796.  Dr.  Edward 
Jenner  was  an  English  physician,  and  the  pro- 
mulgation of  the  discovery  made  by  him  was 
so  rapid,  that  in  six  years  time  it  became 
known  throught  the  civilized  world. 

Aided  by  the  discoveries  of  that  best  hand- 
maid of  medical  science,  namely,  organic  chem- 
istry. Sir  James  Young  Simpson  discovered  the 
ansesthetical  properties  of  chloroform  and  intro- 
duced the  use  of  it  in  1847,  when  Professor  of 
Medicine  at  the  University  of  Edinburgh.  A 
new  era  was  brought  about  in  chirurgical 
science,  and  a  means  introduced  whereby  sur- 
geons now  perform  operations  and  patients  sub- 
mit to  them,  even  when  of  a  prolonged  nature, 
without  the  necessity  of  pain,  and  yet  the 
required  operations,  although  of  the  greatest 
magnitude,  can  be  well  and  perfectly  executed. 
And,  moreover,  the  mortality  prior  to  the  use 
of  anaesthetics,  which  was  very  great  after 
major  operations,  has  been  most  materially 
lessened.  .... 

I  am  confident,  gentlemen,  that  you  cannot 
have  failed  to  notice  that  the  prime  discoveries 
thus  hastily  brought  before  you,  namely,  the 
circulation  of  the  blood  by  Harvey,  the  greatly 
extended  knowledge  of  anatomy  by  William 
Hunter,  the  ligation  of  arteries  by  John 
Hunter,  the  protective  power  of  vaccination  by 
Jenner,  the  use  of  anaesthetics  by  Professor 
Simpson,  these  have  all  been  achieved  by 
sons  of  Biitain,  discoveries  which  have  ad- 
vanced immensely  our  knowledge  of  physiology 
and  anatomy,  the  practice  of  surgery,  the  prac- 
tice of  medicine,  and  the  extension  of  the  ma- 
teria medica,  thus  every  de{)artment  of  the 
science  and  art  of  medicine. 

Surely  as  Englishmen,  and  the  descendants 
of  Englishmen,  we  may  take  a  just  pride  in  the 


honoims  gained  by  our  ancestors,  and  uiay  fur- 
ther trust  in  the  belief  that  the  energies,  indus- 
tries, and  mental  powers  ])08sessed  by  them 
have  not  been  lessened  in  her  sons  simj)ly  by 
the  fact  of  our  having  transplanted  England's 
institutions,  her  laws,  and  her  language  to  this 
western  coniinent. 

"  Ccelum,  non  animum,  mutant^  qui  trans  mare 
currant." 


SYNOPSIS   OP   DR.   GRASETT'S  OPEN- 
ING ADDRESS  AT  TRINITY 
MEDICAL  SCHOOL. 

After  according  a  hearty  welcome  to  the  old 
students  who  were  present,  and  especially  to 
the  new,  the  lecturer  proceeded  to  defend  the 
custom  of  holding  introductory  lectures,  regard- 
ing them  as  useful  opportunities  of  conveying 
timely  words  of  encouragement  and  advice, 
and  deprecating  the  practice  of  some  in  making 
them  vehicles  of  discouragement.  He  re- 
ferred to  the  difficulty  of  selecting  a  subject  for 
the  address,  there  being  no  unbroken  ground, 
and  then  proceeded  to  narrate  briefly  the  pro- 
gress of  the  School  and  the  advantages  of 
medical  education  presented  of  late  years.  In 
old  times  the  system  of  apprenticeship  was  in 
vogue,  and  the  old  Medical  Board  tested  a 
man's  qualifications.  Then  King's  College 
appeared,  followed  by  University  College, 
which  soon  lost  its  medical  faculty.  The 
establishment  of  Trinity  College  by  the  late 
Bishop  Strachan  was  then  referred  to,  and  the 
reader  claimed  the  present  school  as  a  lineal 
descendant  of  its  old  medical  faculty  which 
had  lain  dormant  for  so  many  years.  In  con- 
nection therewith  he  eulogistically  referred  to 
the  late  Edward  Hodder,  the  well  known 
gynaecologist ;  to  the  gentle  and  gentlemanly 
Beaumont,  the  accomplished  surgeon ;  and  to 
the  amiable  Bovell,  a  man  of  perspicacity  and 
learning,  a  cultivator  of  the  science  of  medi- 
cine. After  a  period  of  desuetude  the  old 
faculty  was  revived  by  the  infusion  of  new 
blood,  some  12  or  13  years  ago ;  and  after  a 
few  years,  incorporation  as  a  teaching  institu- 
tion separate  from  the  College  was  sought  and 
obtained.  In  the  old  faculty  7  lecturers  were 
sufficient,  now  13  are  required.     After  a  com- 


OF   MEDICAL  SCIENCE. 


381 


plimentaiy  allusion  to  the  present  faculty  he 
informed  the  students  that  they  had  duties 
which  must  be  properly  performed.  A  prime 
qualification  for  the  student  was  a  good  general 
education  ;  he  deemed  a  college  course  desir- 
able, and  quoted  from  a  report  of  the  visitors 
to  the  Scottish  Universities,  and  from  his  own 
experience  of  college-bred  men  in  Edinburgh  in 
support  of  this  view.  He  advocated  -cultiva 
tion  of  the  natural  sciences,  and  the  establish- 
ment of  a  short  summer  session  for  the  study 
of  botany,  natural  history,  and  chemistry.  He 
thought,  too,  that  this  would  be  a  grand  oppor- 
tunity for  teaching  practical  physiology  and 
pathology,  minor  and  operative  surgery.  He 
would  also  have  one  or  two  summer  courses  in 
physical  diagnosis  obligatory  upon  the  student. 
To  learn  anatomy,  careful,  painstaking  dissec- 
tion was  the  one  thing  necessary,  as  illustrated 
by  John  Hunter.  This  year,  he  was  glad  to 
announce,  they  were  to  have  the  services  of  an 
additional  able  demonstrator  (Dr.  Teskey). 
He  next  referi-ed  to  the  rapid  growth,  and  in- 
creased importance  of  physiology,  and  said  that 
they  were  particularly  fortunate  in  securing 
the  services  of  a  lecturer  (Dr.  Sheard)  who 
had  made  this  subject  and  practical  pathology 
a  special  study.  Clinical  work  at  the  Hospital 
he  regarded  as  extremely  important ;  in  fact 
the  keystone  of  the  medical  edifice.  The  hos- 
pital had  been  raised  to  great  efiiciency  by  the 
united  efforts  of  the  trustees  and  medical 
Superintendent,  and  now  embraced  the  three 
departments  of  a  General  and  Lying-in-Hos- 
pital and  an  Eye  and  Ear  Infirmary.  The 
system  of  clinical  lectures  now  inaugurated  he 
thought  would  prove  the  strongest  point  of 
the  faculty  from  this  time  forward.  Students 
would  find  that  self-culture  was  the  result  of 
caretul  clinical  work,  and  from  simple  observa- 
tion deductions  of  great  import  might  arise  as 
in  the  case  of  Jenner  and  the  milkmaid,  and 
of  Galvani  and  the  frog.  Let  them  keep  their 
eyes  and  ears  open,  and  they  would  become  in 
time  themselves  elucidators  of  nature's  pro- 
cesses. But  too  constant  application  was  not 
to  be  commended.  Physical  exercise  should 
not  be  neglected,  and  one  afternoon  and  even- 
ing in  every  week  should  be  set  apart  for 
relaxation.     As  to  the  mode  of  a  student's  life  : 


Parents  were  often  unduly  apprehensive  of  the 
temptations  which  beset  his  path.  Such  un- 
doubtedly did  exist ;  but,  if  in  any  the  power 
to  resist  were  wanting  he  had  better  abandon 
the  profession.  One  temptation,  however,  he 
would  single  out  for  mention,  although  it 
might  seem  outre,  and  that  was  the  besetting 
evil  of  intemperance.  He  could  not  refrain 
from  warning  them  against  it,  because  he  had 
witnessed  its  blighting  influence  on  so  many  of 
his  own  contemporaries  and  compeers.  He 
defen  led  the  character  of  medical  students 
from  the  aspersions  commonly  cast  upon  them, 
and  advised  them  to  foster  the  natural  quality 
of  sympathy  with  patients,  as  being  a  thera- 
peutic means  of  grand  importance,  and  quoted 
Sir  James  Simpson's  warm  laudation  of  fem- 
inine qualities  in  the  sick  room.  In  the  way 
of  general  advice  he  would  say  to  the  students 
that  their  difficulty  arose  from  irresolution- 
Diligence,  honesty  of  purpose,  industry,  and 
well-formed  habits  were  their  stock  in  trade. 
Habits  of  study  must  not  cease  with  gradua- 
tion for  their  subject  was  interminable.  Mem- 
bers of  the  graduating  class  would  soon  become 
general  practitioners,  asylum  physicians, 
specialists  of  one  sort  or  another,  but  he  could 
advise  them  that  in  whatever  department  they 
might  cast  their  lot  a  general  knowledge  of 
the  whole  broad  field  of  medicine  was  a  prime 
necessity.  Too  sanguine  expectations  must 
not  be  formed  in  the  beginning.  Success 
demands  a  long  courtship  and  unintermitting 
toil.  The  early  disappointments  of  Sir  Astley 
Cooper  and  a  well-known  Philadelphia  sui'geon 
were  cited  as  examples  of  the  fate  of  many  who 
proved  ultimately  successful ;  but  with  the 
true  physician  pecuniary  rewards  were  not  the 
main,  but  rather  the  last,  consideration. 

•  m^m  . 

Alum  for  Lead  Colic. — Dr.  Geo.  C.  Pitzer 
says  this  is  an  excellent  remedy  in  lead  colic  : 

Alum 3ij; 

Dilute  phosphoric  acid 3jj 

Orange-flower  water ) .. 

Water f    ^*3'J' 

M.  S.  One  tablespoonful  every  hour. 

This  will  frequently  relieve  the  nausea,  relax 
the  spasm,  and  open  the  bowels  when  other 
drugs  fail  to  afford  any  relief. — Anier.  Med  Jour, 


382 


CANADIAN  JOURNAL 


THE  SEMI-CENTENNIAL  JUi3lLEE  OF 
McGILL  MEDICAL  FACULTY. 

The  oldest  medical  school  in  Canada,  the 
tenth  oldest  in  America,  celebrated  the  open- 
ing of  its  fiftieth  session  on  the  4th  and  5th  of 
last  month.  The  Medical  Faculty  of  McGill 
College  is  really  older  than  fifty  years,  for  it 
lost  three  sessions  during  rebellion  times,  and 
it  is  owing  to  this  intermission  that  1882-83  is 
its  fiftieth  session. 

The  proceedings  commenced  with  an  intro- 
ductory lecture  by  the  I'ecently  appointed 
Dean,  Dr.  R.  P.  Howard,  in  the  theatre  of  the 
Redpath  Museum,  on  the  evening  of  the  4th 
October.  The  seats  were  filled  by  students 
and  graduates  of  the  University,  as  well  as  by 
many  invited  guests.  The  subject  of  the  ad- 
dress was  a  histoi'y  of  the  founders  of  the 
school,  with  a  sketch  of  the  life  of  the  late 
Dean,  Dr.  Ceorge  Campbell.  At  the  conclu- 
sion of  the  lecture,  all  adjourned  to  the  Mu- 
seum, where  a  conversazione  was  held,  an 
entertainment  made  pleasant  and  interesting 
from  the  number  of  graduates  who  had  come 
from  their  homes  to  take  part  in  the  rejoicing 
over  the  successful  career  of  their  College. 
Upwards  of  six  hundred  people  attended  the 
reception,  and  it  was  regarded  as  one  of  the 
most  successful  entertainments  of  the  kind 
ever  held  in  Montreal.  The  following  day  was 
spent  by  those  who  had  come  from  a  distance, 
in  visiting  old  haunts  and  hunting  up  old 
friends.  The  wards  of  the  General  Hospital 
were  the  chief  attraction.  The  College  class- 
rooms and  the  dissecting-room,  however,  re- 
ceived their  share  of  attention.  Old  boarding- 
houses  and  landladies  were  not  forgotten. 

The  great  event  of  the  Jubilee  was  the  din- 
ner. Many  more  graduates  arrived  just  in 
time  for  it.  On  the  evening  of  the  5th  there 
sat  down  some  two  hundred  and  twelve  guests, 
in  the  magnificent  dining  hall  of  the  Windsor 
Hotel.  Of  these  about  one  hundred  and  ninety 
were  medical  graduates  of  McGill.  The  seats 
were  ari'anged  in  such  a  way  that  men  of  the 
same  cla.ss  sat  near  one  another.  Many  an 
antique  joke  was  unearthed,  many  an  old  story 
retold. 

The  senior  classes  were  well  represented. 
Dr.  Workman  represented  '35.     His  only  sur- 


viving class-mate,  Dr.  Hurt,  sent  his  congratu- 
lations to  the  Dean  and  Faculty,  with  regrets 
that  advancing  age  and  domestic  afiHiction  pre- 
vented his  leaving  his  home  in  Louisiana  to 
join  in  the  celebration.  No  '42  or  '4G  men 
were  present.  These  two  classes  have  gone 
where  all  college  classes  go.  '4.3  sent  up  one 
graduate.     '47,  '48  and  '50  turned  out  in  force. 

Among  the  guests  seated  at  the  principal 
table  were:  Dr.  Chadwick,  representing  Har- 
vard ;  President  Buckham,  of  the  University 
of  Vermont ;  Dr.  Covernton,  of  Trinity  Col" 
lege,  Toronto  ;  Dr.  Workman,  representing  the 
Toronto  School  of  Medicine ;  Hon.  D.  A.  Smith, 
Mr.  Hugh  McLennan,  Dr.  d'Orsonnens  and 
Dr.  Rottot,  representing  the  French  Schools, 
and  Mr.  David  Morrice,  the  founder  of  the 
Morrice  Scholarship  in  Physiology  at  McGill. 

The  Lieut. -Governor  of  Quebec,  himself  a 
graduate  in  medicine  of  1860,  sat  at  the  Dean's 
right  hand. 

The  toasts  customarily  given  on  such  occa- 
sions were  duly  honoured.  Immediately  after 
the  response  to  the  toast  of  the  Sister  Profes- 
sions, the  Dean  said  he  had  a  most  gratify- 
ing announcement  to  make.  He  read  to  the 
company  a  letter  which  he  had  just  received 
from  one  whose  name  he  could  not  divulge. 
The  writer  offered  $50,000,  a  gift  to  the  Medi- 
cal Faculty,  as  a  nucleus  for  an  endowment 
fund,  if  by  the  first  of  August  next  an  equal 
amount  were  subscribed  by  others. 

A  tremendous  burst  of  cheering  followed 
this  wholly  unexpected  announcement. 

During  the  course  of  the  evening  congratu- 
latory telegrams  were  received  from  various 
parts  of  the  globe.  The  new  College  of  Phy- 
sicians and  Surgeons,  of  Chicago,  sent  greeting, 
"  the  infant  to  the  matron."  The  announce- 
ment that  the  Professors  and  students  of  Trinity 
College,  Toronto,  had  sent  by  telegraph  their 
congratulations,  was  received  with  the  most 
enthusiastic  applause. 

The  Secretary  was  instructed  to  transmit  by 
telegraph  to  Dr.  Roderick  Macdonald,  of  Corn- 
wall, the  oldest  McGill  graduate  alive,  expres- 
sions of  regret  at  his  absence,  and  on  behalf  of 
the  assembled  company  to  wish  him  all  happi- 
ness and  prosperity. 

A  graduate,  with  commendable  affection  for 
his  College,  sent  a  cablegram  from  Edinburgh. 
One  also  arrived  from  California. 

At  a  late  hour  the  gathering  broke  up,  the 
banquet  having  been  a  thorough  success,  and 
the  occasion  one  to  be  remembered  by  all  who 
were  present. 


TH  E 


1>^ 


dtanabian  |0iirnal  of  ^timl  ^rimtt 

A  MONTHLY  JOURNAL  OF  MEDICAL  SCIENCE,  CRITICISM,  AND  NEWS. 


U.  OGDEN,  M.D., 

R.  ZIMMERMAN,  M.D.,  L.R.C.P.,  Lond 


\  ConmUimg  Editors.     I         *•  "'  WBIGHT,  B.A.,  M.B.,  M.R.C.S..  Eng..  I  Editor*. 
, )  I         I.  H.  CAMERON,  M.B.,  f 


SUBSCJRIPTIOIV,   $3    PER   ANIVUM. 


i^  All  literary  oommunioations  and  Szohanges   should  be  addressed  to  Dr.  CAMBRON,  273  Sherbonme  St. 

SS"  All  business  oommunioations  and  remittances  should  be  addressed  to  Pr.  WRIGHT,  20   Qerrard  Street 
Cast. 

TORONTO,  DECEMBER,  1882, 


REPORT  ON  OPHTHALMOLOGY  AND 
OTOLOGY. 

BY    A.    M.    ROSEBRUGH,    M.D. 

(Read  before  the  Ontario  Medical  Assoc,  June,  1882.) 

The  ophthalmoscope  was  invented  in  185L 
Von  Grsef6  commenced  his  brilliant  career  the 
same  year,  or  the  year  previous.  In  1854  Yon 
Grseffe  and  Donders  established  the  "  Ai'chives 
fur  Ophthalmolgie,"  and  in  1860  Prof.  Donders 
published  his  great  work  on  "  Accommodation 
and  Refraction."  About  the  same  time  Snellen 
constructed  his  *' Test  Types."  In  1865  Yon 
Grsef^  discovered  that  iridectomy  will  relieve 
intraocular  pressure  in  glaucoma;  and  in  1867 
he  gave  the  world  the  modern  operation  for 
hard  cataract. 

The  invention  of  the  ophthalmoscope,  then, 
may  be  said  to  mark  the  commencement  of  a 
new  era  in  ophthalmic  medicine  and  surgery. 
We  may  not  pause  to  even  enumerate  the 
pathological  conditions  that  may  be  observed 
with  the  eye  mirror.  Ophthalmoscopic  litera- 
ture has  already  reached  large  proportions. 
"We  may  say  in  general  terms,  however,  that, 
with  the  exception  of  the  ciliary  processes,  and 
a  narrow  zone  of  the  anterior  expanse  of  the 
retina,  all  the  structures  of  the  inner  eye,  with 
the  aid  of  the  ophthalmoscope,  are  brought 
under  the  eye  of  the  observer. 

Except  in  a  few  cases  where  the  disease  has 
no  ocular  expression,  the  ophthalmoscope  en- 
ables us  to  find  a  cause  for  all  the  forms  of 
blindness  formerly  called  amaurosis  and  ambly- 
opia.    The  ophthalmoscope  is  also  a  valuable 


aid  in  diagnosing  diseases  of  the  nervous  cen- 
tres, as,  for  instance,  coarse  disease  at  the  base 
of  the  brain  ;  and  quite  recently  the  ophthal- 
moscope has  been  recommended  as  a  means  of 
diagnosing  diseases  of  the  inner  ear. 

The  treatise  of  Prof,  Donders,  of  Utrecht 
on  the  optical  defects  of  the  eye,  which  ap- 
peared in  Holland  in  1860,  and  which  was 
afterwards  translated  and  published  by  the 
New  Sydenham  Society,  is  still  a  standard 
text-book.  In  the  choice  of  spectacles,  Don- 
ders' great  work  is  the  foundation  of  our  thera- 
peutics. 

Donders  was  enabled  to  eliminate  the  vari- 
able from  the  fixed  refraction  of  the  eye,  and 
discoveied,  Jirst,  that  presbyopia  is  not  a  re- 
fractive error,  but  is  simply  a  gradual  lessen- 
ing of  the  focal  adjusting  power,  or  accommo- 
d:ition  of  the  eye,  and  usually  commences  as 
early  as  at  the  age  of  15  years  ;  secondly,  that 
in  the  original  structure  of  the  globe,  the 
antero-posterior  diameter  of  the  eye  may  be 
elongated  or  shortened,  causing  excessive  or 
deficient  refraction,  and  called  respectively 
myopia  and  hyperopia;  thirdly,  that  the  re- 
fraction of  the  different  meridians  of  the  eye 
may  be  unequal.  Thus,  in  the  vertical  meri- 
dian, for  instance,  the  refraction  may  be 
normal,  while  the  horizontal  meridian  may  be 
either  myopic  or  hyperopic,  and  that  this  con- 
dition, called  astigmatism,  may  be  simple,  or  it 
may  be  complicated  with  myopia  or  hyperopia. 
For  paralyzing  the  accommodation,  Dondei-s 
dropped  into  the  conjunctival  sac  a  few  drops 
of  a  solution  of  atropine,  4  grs.  to  the  ounce. 

Donders  also  demonstrated  that  errors  of 
refraction  are  important  factors  in  the  causa- 
tion of  strabismus, — that  fully  75  per  cent,  of 


384 


CANADIAN  JOURNAL 


cases  of  convergent  strabismus  are  caused  by 
hyperopia,  that  a  large  number  of  cases  of 
divergent  strabismus  are  due  to  myopia,  and 
that  the  development  of  the  strabismus  may  be 
an-ested  by  the  early  correction  of  the  optical 
defect  by  the  use  of  suitable  spectacles,  and 
also  that  after  a  tenotomy  has  been  performed, 
the  wearing  of  spectacles  is  often  necessary  to 
prevent  a  relapse  of  the  deformity. 

More  recently,  it  has  been  satisfactorily  de- 
monstrated that  the  irritation  arising  from 
uncorrected  errors  of  refraction  may  cause 
various  eye  troubles,  such  as  phlyctenular  in- 
flammation of  the  cornea,  or  conjunctiva, 
blepharitis  marginalis,  neuro-retinal  conges- 
tion, «fec. 

Ophthalmology  has  been  wonderfully  ad- 
vanced by  the  adoption  of  Standard  Test  Types. 
The  average  acuteness  of  vision  in  the  visual 
line — that  is,  at  the  fovea  centralis  retinae  is 
taken  as  ^'^  of  a  degree.  Capital  letters,  vary- 
ing in  size  from  ;^  to  4  inches  in  length,  printed 
on  a  large  card,  are  so  constructed  that  the 
diameter  of  the  perpendicular  stroke  of  each 
series  of  letters  shall  equal  exactly  -g^^  of  a 
degree,  when  viewed  from  a  fixed  distance 
designated :  thus,  No.  15  should  be  seen  dis- 
tinctly at  15  feet,  No.  20  at  20  feet,  No.  100 
at  100  feet,  and  so  on.  When  a  patient  can 
distinguish,  say  No.  20  at  20  feet,  his  vision  is 
considered  normal,  and  is  indicated  by  the 
fraction  U,  or  unity.  If,  however,  he  can  only 
distinguish  No.  100  at  20  feet,  his  vision 
would  be  expressed  by  the  fraction  ^^, — that 
is,  the  distance  at  which  the  letters  are  actually 
seen  is  divided  by  the  distance  at  which  the 
letters  might  be  seen  with  normal  vision. 

In  modern  ophthalmology,  in  addition  to 
making  a  careful  record  of  the  acuteness  of 
vision  in  the  visual  line,  note  is  also  made  of 
the  field  of  vision.  This  may  be  clouded,  or 
completely  obliterated  in  certain  directions,  and 
may  be  caused  by  detachment  of  the  retina, 
haemorrhagic  effusions,  tumours,  &c 

Before  giving  a  favourable  prognosis  in  cat- 
aract cases,  the  extent  of  the  visual  field  is 
carefully  examined. 

In  certain  cases  colour  tests  are  also  used,  as 
it  has  of  late  been  demonstrated  that  colour 
blindness  may  be  an   acquired  lesion.     In  to- 


bacco amaurosis,  for  instance,  a  seaman  or  a 
railroad  man  mny  be  able  to  attend  to  his 
ordinary  duties,  but  fail  to  distinguish  between 
a  red  or  a  green  signal.  Hence  such  persons 
should  be  examined  i)eriodically  for  colour 
blindness. 

We  are  indebted  to  Von  GrsefS  for  the  mod- 
ern treatment  of  glaucoma.  He  had  noted  the 
fact  that  iridectomy  reduces  the  normal  tension 
of  the  eye.  When,  therefore,  it  was  subse- 
quently discovered,  by  the  combined  aid  of  the 
ophthalmoscope  and  pathological  examination, 
that  glaucoma  is  caused  by  excessive  intraocu- 
lar pressure.  Von  Grsefd  immediately  tried  .the 
effect  of  iridectomy  in  relieving  the  intraocular 
pressure,  and  gave  to  the  world  a  cure  for  an 
hitherto  incurable  disease. 

During  the  last  15  or  20  years,  a  complete 
revolution  has  taken  place  in  the  treatment  of 
cataract*  By  the  combined  use  of  the  ophthal- 
moscope and  oblique  illumination,  the  different 
varieties  of  cataract  can  be  differentiated,  and 
the  state  of  the  development  of  the  opacity 
accurately  ascertained.  With  facilities  for 
making  an  accurate  diagnosis,  improved  oper- 
ative procedures,  and  with  the  judicious  adap- 
tation of  the  operation  to  each  case,  the  results 
of  treatment  are  at  least  as  satisfactory  as  in 
any  other  class  of  surgical  cases. 

Statistics  have  been  collected  of  11,000  cases 
of  hard  cataract  treated  by  the  old  "  flap " 
operation  previous  to  1868 ;  and  of  11,000 
cases  treated  by  the  modern  operation, — show- 
ing that  with  the  former  there  was  a  total  loss 
of  sight  in  16.7  per  cent,  of  the  cases,  and  that 
with  the  latter  operation  the  total  loss  was  6. 5 
per  cent. ;  still  further,  that  of  1,000  cases  of 
hard  cataract  operated  upon  by  Von  Grsefe 
between  1865  and  1869,  the  total  loss  was  less 
than  3  jier  cent.  In  the  modern  operation,  for 
which  we  are  indebted  to  Von  Grsef^,  the 
triangular  Beer's  Knife  and  the  semicircular  cor- 
neal flap  are  discarded,  and  a  narrow  knife  and 
a  straighter  and  more  peripheral  cut  substituted. 
The  cut  is  made  more  nearly  in  the  direc- 
tion of  a  great  circle  of  the  globe,  and  a  sector 
of  the  iris  is  removed,  so  as  to  facilitate  the 
extension  of  the  lens,  and  prevent  prolapse  of 
the  iris. 

It  is,  perhaps,  almost  unnecessary  to  state, 


OF     MEDICAL  SCIENCE. 


385 


that  the  old  operation  of  "  couching,"  oi'  push- 
ing the  lens  back  into  the  vitreous,  has  been 
completely  abandoned,  as  it  was  found  that 
fully  50  per  cent,  of  the  cases  thus  treated 
were  ultimately  lost  from  destructive  inflam- 
mation. 

The  treatment  of  strabismus  and  paralysis  of 
ocular  muscles  in  late  years  has  been  modified 
and  improved.  By  the  operation  called  "layer- 
ing forward,"  the  insertion  of  a  weakened 
muscle  is  aivanced  nearer  the  cornea.  Teno- 
tomy of  a  contracted  muscle  is  performed  sub- 
con  juncti  vail  j.  A  conjunctival  suture  is  used 
to  modify  the  effect  of  an  operation,  and  pris- 
matic spectacles  are  used  to  relieve  diplopia 
and  muscular  strain. 

With  the  modern  improved  methods  of  pre- 
paring tissue  for  the  microscope,  there  has  been 
an  advance  in  our  knowledge  of  the  normal 
and  pathological  histology  of  the  eye,  but  we 
can  not  stop  to  particularize. 

Quite  recently  the  extraordinary  discovery 
has  been  made  that  in  the  living  retina  there 
is  secreted  a  photo-chemical  matter,  called  the 
*'  visual  purple,"  which  is  bleached  in  a  bright 
light,  and  re-secreted  in  the  dark.  It  is  said 
to  be  an  albuminoid  secretion,  confined  to  the 
layer  of  rods,  and  is  believed  to  be  a  conserva- 
tive element  which  enables  the  eye,  in  con- 
junction with  the  iris,  to  adapt  itself  to  varia- 
tions in  the  intensity  of  the  light. 

An  advance  has  been  made  in  our  knowledge 
of  the  etiology  of  glaucoma.  The  prominent 
symptom  in  glaucoma  is  excessive  intraocular 
tension.  The  eye  is  hard  and  unyielding. 
Until  recently,  this  condition  was  supposed  to 
depend  upon  hyper-secretion  of  the  choroid.  It 
is  now  known  that  this  is  not  necessarily  the  case, 
and  that  the  loss  of  equilibrium  of  intraocular 
pressure  may  be  caused  by  any  interference 
with  exosmosis  or  filtration  from  the  eye,  that 
pressure  of  the  peripheral  part  of  the  iris 
against  Fontana's  spaces  and  Schlemm's  canal — 
at  the  so-called  "  iritic  angle,"  causes  glaucoma, 
not  from  any  increase  in  the  secretion  from  the 
iris  or  choroid,  it  is  claimed,  but  by  mechani- 
cally interfering  with  exosmosis  or  filtration 
through  the  trabeculae  of  the  anterior  scleral 
ring. 

Iridectomy,  or  the  removal  of  about  ^  of  the 


iris,  was  supposed  to  relieve  the  intraocular 
pressure  by  removing  a  large  secreting  surface, 
but  its  action  is  now  believed  to  depend  partly 
upon  the  removal  of  pressure  at  the  iritic  angle, 
and  partly  upon  filtration  being  favoured  by  the 
cicatrix,  in  the  anterior  scleral  ring. 

The  construction  of  the  ophthalmoscope  has 
been  greatly  improved  of  late  years.  The  form 
now  in  general  use  is  Knapp's  and  Loring's. 
A  disc  is  secured  behind  the  mirror  which  can 
be,  rotated,  and  which  carries  a  series  of  very 
small  convex  and  concave  lenses  behind  the 
central  aperture  of  the  mirror.  By  this  con- 
venient arrangement,  any  optical  defect  either 
in  the  eye  of  the  observer,  or  in  the  eye  under 
observation,  is  counterbalanced.  By  suspend- 
ing the  accommodation  and  rotating  the  lenses 
behind  the  mirror,  the  latter  being  brought 
close  to  the  eye  under  observation,  the  refrac- 
tion can  be,  at  least  approximately,  determined ; 
and  it  is  possible  to  prescribe  the  proper  cor- 
recting spectacles  by  this  method  alone.  In 
prescribing  spectacles,  however,  this  method  of 
examination  is  rather  resorted  to  for  the  pur- 
pose of  confirming  the  result  of  the  examina- 
tion made  with  the  test  types  and  trial  glasses, 
— with  or  without  paralyzing  the  accommoda- 
tion. 

Among  the  operative  procedures  which  may 
be  said  to  be  on  trial  may  be  mentioned  optico- 
ciliary neurotomy  as  a  substitute  for  enuclea- 
tion ;  sclerotomy  as  a  substitute  for  iridectomy 
in  certain  forms  of  glaucoma,  and  Loring's 
discission  of  the  iris  for  closed  pupil  after  cat- 
aract operations. 

Eserine  is  being  substituted  for  atropine  in 
connection  with  cataract  operations,  and  in  the 
after  treatment  of  extraction,  the  eye  is  now 
less  interfered  with  than  formerly.  If  there  is 
no  cedema  of,  or  discharge  from  between  the 
eyelids,  it  is  now  advised  to  keep  ths  eye  closed 
for  about  7  days  after  the  operation.  For  the 
removal  of  chips  of  iron  or  steel  from  the  in- 
terior of  the  eye,  the  permanent  magnet  is 
giving  place  to  the  more  powerful  electro-mag- 
net. 

Antisepsis,  which  has  proved  a  boon  in  gen- 
eral surgery,  has  been  tried  in  ophthalmic 
surgery,  but  not  with  encouraging  results;  and, 
moreover,  the  practical  difficulties  in  the  way 


386 


CANADIAN  JOURNAL 


of  carrying  out  strictly  antiseptic  treatment  in 
ordinary  eye  oi)eration8,  seem  to  be  almost  in- 
surniountahle.  The  eye  is,  however,  sponged 
with  antiHeptic  solutions  before  and  after  oper- 
ations, and  caution  is  used  to  prevent  the 
infection  of  wounds  from  blenorrhoia  of  the 
lachrymal  sac,  the  discharges  from  trachoma, 
&c.,  and  where  atropine  or  e^erine  is  used 
continuously  for  some  time,  it  is  considered 
advisable  that  these  salts  (which,  by-the-way, 
should  be  quite  neutral)  should  be  dissolved  in 
a  two  or  three  per  cent,  solution  of  boracic 
acid.  Boracic  acid  solutions  are  also  used  in 
cases  where  there  is  purulent  discharge. 

Among  the  new  remedies  recently  intro- 
duced into  ophthalmic  practice,  duboisia  and 
homatropine  dilate  the  pupil,  while  eserine  and 
pilocarpine  contract  it.  Duboisia  can  be  sub- 
stituted for  atropine  in  the  exceptional  cases 
where  the  latter  is  found  to  irritate  the  con- 
junctiva. Atropine  is  the  most  reliable  for 
dilating  the  pupil  in  plastic  iritis.  It  also  acts 
as  an  anodyne  to  the  sensitive  nerves  of  the 
iris  and  cornea.  But  it  is  contra-indicated 
where  there  is  a  tendency  to  glaucomatous 
complications, — or  in  serous  iritis,  on  account 
of  its  tendency  to  increase  intraocular  tension ; 
in  the  latter  case,  homatropine  is  substituted 
for  the  atropine. 

In  cases  where  it  is  simply  desirable  to  dilate 
the  pupil  temporarily,  as,  for  instance,  for  an 
ophthalmoscopic  examination,  homatropine, 
used  in  a  weak  solution,  will  dilate  the  pupil 
without  paralyzing  the  accommodation,  and  its 
eflect  upon  the  pupil  is  more  transitory  than 
that  of  atropine.  Used  in  stronger  solutions, 
say  5  or  6  grains  to  the  ounce,  homatropine 
will  paralyze  the  accommodation,  and  the  para- 
lysis is  not  nearly  so  persistent  as  it  is  after 
using  atropine  solutions.  This  is  an  advantage 
in  favour  of  homatropine  in  treating  anomalies 
of  refraction. 

Eserine  is  used  both  for  contracting  the 
pupil  and  relieving  intraocular  tension.  It  is 
a  valuable  adjunct  in  the  treatment  of  glauco- 
ma, and  in  some  cases  may  alone  ward  off  an  in- 
flammatory attack.  By  lelieving  intraocular 
pressure,  it  is  a  valuable  remedy  in  suppurativa? 
and  ulcerative  diseases  oi  the  cornea. 

Pilocarpine  is  not  so   powerful  a  myotic  ao 


eserine,  and  is  not  much  used  as  a  local  appli- 
cation. Used  hypoderniically,  however,  in  ^ 
or  J  grain  doses,  it  acts  beneficially  upon 
scleral  and  episcleral  disease,  and  is  recom- 
mended for  sub-retinal  effusion  and  opacities  of 
the  vitreous. 

Pugenstecher  thinks  massage  occupies  a  very 
important  place  in  ocular  therapeutics.  He 
uses  either  circular  or  radial  friction  of  the 
eye  with  the  finger  against  the  closed  lid,  mak- 
ing very  light  and  rapid  motion.  It  is  recom- 
mended in  old  corneal  opacities,  in  pustular 
conjunctivitis,  in  scleritis  and  episcleritis. 
Pagenstecher  prefers  combining  the  massage 
with  the  use  of  the  oxide  of  mercury  ointment, 
but  claims  very  satisfactory  results  from  the 
massage  alone. 

The  interest  now  taken  in  ophthalmology  is 
quite  remarkable.  An  International  Ophthal- 
mological  Association,  which  meets  every  four 
years,  was  established  about  12  years  ago,  and 
many  vigorous  local  societies  are  now  in  oper- 
ation. The  American Ophthalmological  Society 
numbers  over  75  active  members,  and  quite  a 
large  volume  of  transactions  is  published  an- 
nually. There  are  now  over  one  dozen  jour- 
nals devoted  either  exclusively  or  very  specially 
to  the  advancement  of  this  department  of 
medical  science.  But,  as  we  sometimes  say, 
"It  never  rains  but  it  pours."  During  the 
past  12  months  four  treatises  on  diseases  of 
the  eye  were  issued  by  the  American  press 
alone—  one  written  by  Dr.  Noyes,  of  New 
York,  one  by  Dr.  Williams,  of  Boston,  one  by 
Dr.  Schell,  of  Philadelphia,  and  one  by  Dr. 
Mittendorf,  of  New  York. 


FRACTUHES  OF   PELVIS    AND  SPINE. 

REPORTED  BY  MR.  C.  M.  FOSTER. 

(Under  the  care  of  Dr.  A.  H.  Wright,  Toronto  General 
Hospital. ) 

Susan  K ,  set  20,  a  domestic. 

August  30th,  '82. — While  washing  a  window 
in  an  upper  story  fell  15  feet  to  ground,  li<i;hting 
on  feet,  and  then  falling  on  back.  Was  unable 
to  move. 

August  31st. — Was  brought  into  hospital  24 
hours  after  receiving  the  injury  ;  lay  on  back  ; 
disliked  to   be  moved  ;  countenance  anxious  ; 


OF  MEDICAL  SCIENCE. 


387 


bowels  tympanitic ;  gas  passing  involuntarily 
per  anum ;  paralysis  of  bladder  ;  was  able  to 
move  right  leg  slightly,  but  not  the  left ;  left 
leg  apparently  ^  inch  short ;  crepitus  on  moving 
this  limb,  but  difficult  to  locate  it ;  nothing  ab- 
normal discovered  at  upper  extremity  of  femur 
or  in  hip  joint ;  crepitus  detected  on  pushing 
crest  of  ilium  inwards  about  middle  of  crest ; 
per  rectum  nothing  discovered  ;  per  vaginam 
fracture  evident  about  junction  of  ascending 
ramus  of  ilium  with  descending  of  pubis ; 
slight  bloody  discharge  from  vagina. 

On  turning  her  on  face,  which  caused  much 
pain,  there  was  noticed  slight  deflection  to  the 
right  of  spinous  processes  of  11th  and  12th 
dorsal  vertebrae  ;  also  slight  curvature  in  same 
region,  including  4  or  5  vertebrae  with  concavity 
to  left.  This,  however,  was  suspected  to  be 
ordinaiy  condition,  and  compensatory  toanother 
curve  in  upper  dorsal  region. 

Treatment. — Bandage  applied  round  pelvis  ; 
thighs  slightly  flexed  and  kept  so  by  pillow 
under  knees;  urine  withdrawn  by  catheter; 
opiates  at  bedtime  ;  vagina  washed  out  morning 
and  evening  with  carbolized  water. 

September  3rd. — During  4  days  since  admis- 
sion, paralysis  of  lower  limbs  increased  gradu- 
ally ;  now  unable  to  move  more  than  feet  very 
slightly  ;  sensibility  but  slightly  impaired  ;  dis- 
charge continues  from  vagina  ;  is  now  purulent, 
but  still  small  in  quantity  ;  remains  on  back  ; 
there  is  now  incontinence  of  urine ;  bowels 
constipated  ;  patient  placed  on  water  bed. 

September  13th. — No  evacuation  from  bowels 
since  injury  (2  weeks)  :  castor  oil,  calomel, 
enemata  tried  without  effect.  Constant  current 
ordered  to  be  applied  night  and  morning  over 
abdomen. 

September  15  th. — Copious  evacuation  from 
bowels.     After  this  there  was  incontinence  of 
foeces  as  well  as  urine  ;  bed  sores  appeared,  not 
withstanding  water  bed  and  great  care  on  the 
part  of  the  nurses. 

She  vomited  a  good  deal  at  times  ;  complained 
occasionally  of  pain  in  back  ;  always  dreaded 
being  moved.  She  sank  gradually  until  Sep- 
tember 26th,  when  she  died  28  days  after  the 
accident. 

Post-mortem  examination  15  hours  after 
df  ath. — Body  much^emaciated  ;  deflection  (but 


no  prominence)  of  spinous  processes  in  lower 
dorsal  region  apparent,  also  curvature.  In  ex- 
posing the  spine,  considerable  extravasation  of 
blood  into  the  soft  parts  in  this  region  was  found. 
The  cord  when  laid  bare,  was  found  to  be 
swollen  for  about  2  inches  in  lower  dorsal  region, 
much  softened,  and  in  places  quite  disorganized  ; 
some  congestion  of  meninges  at  this  spot.  On 
removing  last  3  dorsal  and  1st.  lumV)ar  verte- 
brae, fractures  were  discovered.  One  transverse 
extending  through  body  of  11th;  another 
transverse  extending  through  upper  part  of  body 
of  12th  ;  the  right  pedicle  of  this  vertebra  was 
also  fractured  at  root.  On  looking  at  posterior 
surfaces,  a  longitudinal  fracture  was  found  ex- 
tending upwards  through  12lh  and  half  llth, 
thence  extending  obliquely  upwards  and  to  the 
right,  detaching  a  triangular  piece  of  the  latter, 
(llth  dorsal  vertebra),  which  projected  slightly 
backwards  into  canal,  and  caused  some  pressure 
on  cord.  This  was  the  only  marked  displace- 
ment, and  corresponded  with  degeneration  of 
cord. 

The  left  innominate  bone  was  extensively 
fractured ;  one  fracture,  3i  inches  long,  ex- 
tended from  juncture  of  anterior,  and  middle 
thirds  of  crest  of  ilium  to  the  middle  of  greater 
sciatic  notch  ;  another  extended  from  a  point 
just  above  the  posterior  inferior  spinous  process 
to  meet  the  former  2  inches  below  crest.  A 
pii  ce  of  bone,  1  inch  x  ^  inch,  was  separated  at 
the  centre  of  acetabulum  ;  from  this  three  frac- 
tures extended  through  and  beyond  acetabulum, 
one  ending  just  above  spine  of  ischium,  the 
second  passing  through  ilio-pectineal  eminence, 
the  third  passing  directly  downwards  into  back 
part  of  obturator  foramen.  There  was  fracture 
through  lower  part  of  ramus  of  pubes,  and  an- 
other an  inch  below  this  through  ascending 
ramus  of  ischium. 

The  Dr.  considered  it  remarkable  that  a 
slight  person,  such  as  the  patient  was  (probably 
weighing  about  100  pounds  when  she  received 
the  injury),  should  have  received  such  severe 
and  extensive  injuries  from  a  fall  of  15  feet; 
that  so  many  and  extended  fractures  should 
have  occurred  in  both  os  innominatum  and 
spinal  vertebrse  without  more  pronounced  signs 
at  first.  There  was  comparatively  little  dis- 
placement, and  therefore  the  functions  of  the 


388 


CANADIAN  JOURNAL 


cord  were  not  completely  destroyed  by  the 
slight  pressure,  and  the  pelvic  viscera  were  not 
very  seriously  injured.  On  examination  of 
fragments  of  os  innominatum,  one  would  sup- 
pose that  a  rectal  examination  would  have  ena- 
bled him  to  discover  clearly  the  nature  of  tho 
fracture,  but  on  account  of  the  condition  of  the 
patient,  the  examination  was  not  so  thorough 
as  it  would  otherwise  have  been.  It  is  pro- 
bable that  many  fractures  of  the  pelvic  bones 
are  not  clearly  diagnosed  (or  in  some  cases  not 
recognized  at  all),  as  there  is  often  so  little  dis- 
placement, and,  in  consequence,  the  signs  are 
rather  obscure.  In  this  case,  although  the  in- 
nominate bone  was  broken  into  7  distinct  pieces, 
there  was  practically  no  displacement,  and  no 
injury  to  viscera  excepting  a  slight  laceration  ot 
vagina.  It  is  probable  that  the  patient  would 
have  made  a  good  recovery  if  there  had  been  no 
injury  to  spine. 


DISLOCATION  OF  THE  SHOULDER. 

A   Contribution   in   Support  of  Kelley's   Method 
of  Reduction. 

Mrs. ,  widow,  charwoman,  aged  about  40, 

presented  herself  at  the  out-patient  department, 
Toronto  General  Hospital,  saying  that  some 
thirteen  days  previously,  while  returning  from 
work  in  the  evening,  she  had  slipped  and  fallen 
and  hurt  her  shoulder.  At  the  time  of  ex- 
amination there  was  no  swelling  nor  bruising, 
but  marked  flattening  of  the  left  shoulder 
existed,  with  some  prominence  and  marked 
tenderness  beneath  the  coracoid  process.  The 
underhand  motions  of  the  arm  were  pretty  free, 
and  her  hand  could  be  placed  on  the  opposite 
shoulder,  and  even  on  the  top  of  the  head  with 
considerable  facility.  The  surgeon's  fingers 
could  be  readily  made  to  explore  the  glenoid 
cavity,  as  the  patient  was  thin,  and  the  lower 
portion  of  the  head  could  be  felt  in  the  axilla 
upon  elevation  and  rotation  of  the  arm.  The 
free  movement  of  the  arm  and  the  capacity  to 
place  the  hand^on  the  opposite  shoulder  and  on 
the  head  were  certainly  unusual,  but  Dugas's 
test  and  the  other  evidences  of  luxation  men- 
tioned were  too  positive  to  be  mistaken.  There 
Tsas  no  shortening  of  the  limb.  Reduction  was 
first  attempted  by  the  method  recommended  by 


Kocher,  at  the  late  meeting  of  the  International 
.Medical  Congress  in  London.  Kocher's  method 
is  as  follows  : — Tlio  patient  is  seated,  with  the 
surgeon  on  his  left  hand.  The  elbowjoint  is 
first  to  be  flexed  to  a  right  angle,  and  the  joint 
firmly  pressed  against  the  side  of  the  chest, 
then,  while  holding  the  elbow  in  contact  with 
the  body,  the  arm  is  to  be  slowly,  gently,  and 
steadily  rotated  out  until  firm  resistance  is 
encountered  ;  then,  maintaining  this  rotation, 
the  arm  is  to  be  raised  forwards  and  a  little  in, 
and  lastly  to  be  rotated  in,  and  the  hand 
brought  towards  the  opposite  shoulder.  No 
anaesthetic  is  needed,  and  Ceppi  says  the 
method  is  especially  valuable  in  old  disloca- 
tions. 

This  was  repeated  a  second  time  without 
avail.  Kelley's  method  (which  consists  in 
placing  the  patient  on  a  firm  table  of  con- 
venient height,  lying  upon  the  back  so  as  to  fix 
the  scapula  by  the  weight  of  the  body,  with  the 
side  of  the  luxation  drawn  well  to  the  edge, 
while  the  surgeon  extends  the  arm  to  a  right 
angle  with  the  body,  and  then  places  one  of  his 
hips  against  the  patient's  side  well  up  in  the 
axilla,  and  draws  the  extended  arm  around  his 
pelvis,  holding  the  hand  firmly  fixed  upon  his 
ilium,  after  which  position  is  secured,  he  sud- 
denly or  slowly  rotates  his  body  on  its  vertical 
axis  until  his  back  lies  parallel  with  the 
patient's  side),  was  then  tried,  and  with  a 
minimum  of  efibrt  was  at  once  crowned  with 
complete  success,  some  tearing  of  tissue  being 
plainly  heard,  and  the  head  of  the  bone  return- 
ing to  its  socket  with  an  audible  and  sensible 
snap. 


CLINICAL  LECTURE 

GIVEN  BY  DR.  J.  E.   GRAHAM,    IN   TORONTO  GEN'l  HOSP. 

Tinea  Kerion.  — The  vegetable  parasites 
which  grow  on  the  skin  are  : — \.  Tricophyton 
Tonsurans  of  Tinea  Tonsurans.  2.  Achorion 
Schonleinii  of  Favus.  3.  Microsporon  Furfur 
of  Pityriasis  Versicolor. 

The  first  variety,  the  parasite  of  ordinary 
ring-worm,  grows  on  any  part  of  the  body,  and 
when  examined  under  the  microscope  is  found 
to  be  made  up  of  small  round  spores,  often 
arranged  in  the  filaments  of  a  mycelium. 


OF  MEDICAL  SCIENCE. 


389 


On  the  smooth  surface  of  the  body  the  dis- 
ease produced  is  of  a  mild  character,  and  one 
easily  removed.  When,  however,  it  occurs  on 
the  scalp,  it  runs  a  difierent  and  much  more 
obstinate  course.  In  this  situation  the  para- 
site grows  downward  into  the  hair  follicles, 
destroying  to  a  greater  or  less  extent  the  nu- 
trition of  the  hair.  The  latter  is  on  this 
account  short  and  brittle  over  the  diseased 
patches.  Often,  the  parts  affected  become 
quite  devoid  of  hair.  In  somewhat  rare  cases 
the  parasite  produces  by  its  presence  even 
greater  alterations  than  those  mentioned.  In 
scrofulous  children  and  those  in  whom  suppur- 
ation readily  supervenes  on  inflammatory 
action,  a  condition  of  the  scalp  is  produced 
which  is  termed  Tinea  Kerion.  Kerion  was 
first  described  by  Celsus,  but  it  was  only  about 
the  middle  of  the  present  century  that  it  was 
found  to  be  connected  with  the  parasite  of 
ring- worm.  I  present  to  you  to-day  a  boy 
about  seven  years  of  age,  of  a  delicate  consti- 
tution, in  whom  this  condition  is  shown  in  a 
very  typical  form.  Both  he  and  his  younger 
brother  were  affected  with  ring-worm  of  the 
scalp.  In  the  latter,  a  healthy  boy,  you  see 
the  disease  has  pursued  its  ordinary  coTirse. 
You  see  round  and  oval  patches  partly  devoid 
of  hair.  That  which  remains  is  short  and 
brittle.  In  the  elder,  the  more  delicate  boy, 
the  tinea  kerion  is  at  once  recognized.  The 
scalp  presents  several  nodular  elevations,  on 
the  surface  of  which  are  seen  small  pores.  On 
pressure,  a  clear  transparent  fluid  exudes 
through  some,  and  pure  pus  through  others. 
You  see  that  the  patches  vary  in  size  and 
shape,  and  are  exceedingly  tender  to  the  touch. 
Now  in  nodules,  where  supuration  does  not 
exist,  you  could  easily,  by  means  of  the  mi- 
croscope, fi.nd  the  parasite  at  the  roots  of  che 
hairs.  The  latter  come  out  very  readily.  The 
disease  has  been  for  some  months  in  existence, 
but  now,  after  two  weeks'  treatment,  shows 
evident  signs  of  improvement.  The  treatment 
adopted  has  been  (1)  removal  of  scabs  and 
scales,  by  olive  oil  and  occasional  poultices, 
(2)  epilation,  (3)  the  application  of  sulphurous 
acid  and  the  ointment  of  the  iodide  of  sulphur. 
(The  affected  parts  are  first  bathed,  then  sul- 
phurous acid  applied   by  means  of  a   sponge, 


and  afterwards  the  ointment  well  rubbed  in.) 
Other  parasiticide  remedies  may  be  used,  viz., 
citrine  ointment,  solution  of  the  hyposulphite 
of  sodium,  or  a*  weak  solution  of  hydrarg  per- 
chlor.    The  latter  must  be  applied  very  carefully. 

Aortic  Valvular  Disease. — In  my  last  clinical 
lecture  I  brought  before  you  a  well-marked 
case  of  mitral  disease,  in  which  a  systolic  bruit 
at  the  apex  could  be  easily  and  distinctly  heard. 
To-day  I  present  to  you  a  case  in  which  a  sys- 
tolic and  a  diastolic  bruit  can  be  heard  at  the 
base,  the  former  extending  along  the  course 
of  the  great  vessels,  and  the  latter  down  the 
sternum.     The  history  is  as  follows  : — 

W.  J ,   set.  53.     A  pensioner.     He  has 

been  a  soldier  and  sailor,  having  lived  in  vari- 
ous parts  of  the  world.  He  has  never  had  any 
severe  attack  of  illness.  Once  had  gonorrhoea, 
but  no  other  venereal  disease.  In  1861  he  had 
a  mild  attack  of  rheumatism,  and  in  1870  he 
had  a  recurrence  of  the  same  disease.  He  was 
not  obliged  to  remain  in  bed  during  either 
attack.  Since  1870  he  has  been  examined  by 
the  army  suigeon  and  pronounced  healthy,  and 
six  months  ago  he  underwent  a  very  careful 
examination  for  life  insurance.  He  was  passed 
as  a  first-class  risk.  About  five  weeks  ago  he 
was  exposed  to  wet  and  cold,  since  which  time 
he  has  not  felt  quite  well,  being  troubled  with 
want  of  appetite,  sleeplessness,  and  rheumatic 
pains,  especially  in  the  left  shoulder.  About 
three  weeks  ago  he  noticed  shortness  of  breath 
and  a  feeling  of  distrets  in  the  cardiac  region. 
These  were  much  aggravated  on  even  slight 
exertion.  He  came  to  me  two  weeks  ago.  I 
was  at  once  struck  by  the  peculiarity  of  the 
pulse,  which  presented  the  ball-like  character 
in  a  very  marked  degree.  This  led  to  an  ex- 
amination of  the  heart,  when  an  obstructive 
and  a  regurgitant  aortic  murmur  were  heard. 
He  was  ordered  to  keep  quiet,  and  a  mixture 
containing  spts.  seth.  sulph.  co.  and  small  doses 
of  aconite,  was  prescribed.  The  aconite  was 
given  because,  in  my  opinion,'  the  systole  of 
the  heart  was  too  strong,  so  to  speak,  for  the 
requirements  of  the  system.  He  has  since 
very  much  improved.  He  sleeps  well,  and 
does  not  experience  distress  on  slight  exertion. 
There  are  three  or  four  points  I  would  like  you 
to  notice : — 


590 


CANADIAN  JOURNAL 


(1)  The  pulse.  I  took  sphygmo-graphic  trac- 
ings about  ten  days  ago,  and  again  yesterday. 
Tho  latter  you  see  presents  the  peculiar  charac- 
teristic of  aortic  regurgitation.  You  notice 
the  great  and  rapid  ascent  ot  the  primary  wave, 
and  its  sudden  decline.  You  will  notice  the 
game  peculiarities  on  examination  with  the 
finger.  The  sudden  decline  is  caused  by  the 
partial  removal  of  the  vis  a  tergo  from  non- 
closure of  the  aortic  valves. 

(2)  You  will  hear  on  examination  two  ab- 
normal sounds,  both  in  their  greatest  intensity 
at  the  base  of  the  heart.  One,  the  systolic 
bruit,  you  will  also  hear  along  the  great  vessels. 
It  is  produced  by  the  blood  passing  over  the 
rough  6ut  faces  of  the  valves.  The  second,  the 
diastolic  bruit,  is  the  louder  of  the  two,  and 
can  be  traced  down  the  sternum.  It  is  pro- 
duced by  a  regurgitation  of  blood  from  the 
aorta  into  the  Ipft  ventricle. 

(3)  By  examination  yoix  will  find  that  the 
apex  beat  of  the  heart  is  in  the  normal  posi- 
tion, and  that  the  area  of  cardiac  dulness  is 
not  increased.  If  the  valvular  disease  had 
been  long  in  existence,  the  heart  would  be  so 
enlarged  as  to  make  this  condition  quite  evi- 
dent on  physical  examination. 

We  have  then  a  case  of  aortic  valvular  dis- 
ease which,  from  both  the  clinical  history  and 
the  physical  examination,  we  would  conclude 
must  be  of  recent  date.  It  is  probable  that 
the  mild  attack  of  rheumatism  from  which  he 
has  suffered  since  his  exposure  to  wet  and  cold, 
was  accompanied  by  the  much  more  serious 
disease,  endo-carditis.  At  the  present  time 
there  are  most  probably  vegetations  on  the 
margins  of  the  valves,  which  prevent  their 
functions  from  being  properly  performed.  One 
might  almost  call  this  a  case  of  primary  endo- 
carditis, as  the  rheumatic  symptoms  have  been 
of  so  unimportant  a  character. 

He  is  now  taking  potass,  iod.,  and  is  kept 
very  quiet.  There  is  no  indication  in  this  case 
for  digitalis.  Judging  from  the  pulse,  the  left 
ventricle  appears  to  be  acting  too  strongly  as  it 
is,  and  giving  digitalis  would  only  add  fuel  to 
the  fire.  Rest  and  quiet  are  the  main  thera- 
peutic agents. 

Wobler  of  Gottingen,  the  well-known  che- 
mist, is  dead  at  the  age  of  82. 


MALIGNANT  DISEASE  OF  LOWER 
PART  OF  COLON,  UPPER  PART  OF 
RECTUM,  AND  LEFT  SUPRA-RENAL 
CAPSULE. 

BY  R.  ZIMMERMAN,  M.  D. 

Reported  to  Toronto  Medical  Society,  Oct.  19th,  1882. 

A.   B.,  set  25,  compositor.     Family  history. 
Grandfather  said  to  have  died  of  cancer.     No 
other  evidence  of  family  predisposition  could  be 
obtained.       Father   and   mother   living,    aged. 
Previous    history. — Has    suffered    during    the 
past  six  years  from  frequent  attacks  of  nausea, 
vomiting  and  acute  pains  in  the  stomach  and 
bowels,  and  violent  headaches.     Four  years  ago 
had  an  attack  of  ague,  and  two  years  ago  one 
of  diphtheria  (?)    On  Dec.  23rd,  1881,  went  to 
Winnipeg,  and  it  is  stated  that,   while   there, 
again  suffered  from  diphtheria.     The  attacks  of 
nausea,  vomiting,  pains  in  the  stomach,  bowels, 
and  head  increased  in  severity  and  frequency,  and 
he  returned    to   Toronto  about   February  1st, 
1882.     He  now  consulted    Dr.   Graham,  who 
treated  him   till  April  19th,  when  Dr.  G,  on 
leaving    for    Europe,  transferred    him    to    Dr. 
Burns.      At  this  time  he  was  suffering   from 
symptoms  of  lead  poisoning,  colic,  wrist  drop, 
blue  line  on  the  gums,  and  constipation,  alter- 
nating with   diarrhcea.     About   the   middle  of 
May  he  became  an  opium  eater,  his  mother  hav- 
ing, unfortunately,  taught   him  the   habit,  in 
order  to  ease  his  frequent  pains  in  the  abdomen. 
The  preparation  used  was  gum  opium  in  vari- 
able doses  which,  according  to  his  wife,  were 
never  large.      He  desired  earnestly,  and  strug- 
gled hard  to  abandon  this  pernicious  habit,  but 
failed,  and  continued  using  opium  up  to  the  time 
I  was  called  hurriedly  to  see  him,  on  account  of 
profuse   haemorrhage   from    the   bowels.     This 
was  on  August  18th,  when  I  found  him  almost 
pulseless,  having  lost,  as  nearly  as  I  could  judge 
between  25  and  30  ounces  at  least,  of  what  ap- 
peared to  be  arterial  blood.     Ergot  hypodermi- 
cally,  ice  passed  into  the  rectum,  and  turpen- 
tine, gallic  acid,  and  tinct.  cinnamomi  internally, 
and  the  injunction  of  perfect  rest  were  followed 
by  a  cessation  of  the  hsemurrhage,  but  a  trifiing 
amount  passing  on  two  or  three  occasions  after- 
wards.    The  nausea,  and  the  pain  and  vomit- 
ing prevented  medication  by  the  mouth,  (with 


OF  MEDICAL  SCIENCE. 


391 


the  exception  of  bismuth,  pepsin,  and  pulv,  cret. 
CO.  c.  opio  powders  occasionally).  Keliance 
had  to  be  placed  on  morphia  hypodermically, 
and  this  had  to  be  given  in  rapidly-increasing 
doses  up  to  the  time  of  his  death,  which  occurred 
on  Oct.  15th.  During  this  time  he  was  seen 
frequently  by  Dr.  Diamond  and  myself.  Dr. 
Strange  saw  him  once  iu  consultation  and 
agreed  in  the  diagnosis  of  malignant  tumour  of 
the  bowel — an  opinion  formed  by  Drs.  Graham 
and  Burns  in  the  spring.  No  tumour  could  at 
any  time  be  felt,  either  by  rectal  examination 
or  abdominal  palpation,though  he  was  so  emaci- 
ated that  the  latter  was  easy.  Heart  and  lungs 
were  normal.  The  patient  remained  exceed- 
ingly weak,  the  facies  became  cachectic  and 
sallow,  and  he  suffered  acutely  when  not  under 
the  morphia.  Stimulants  could  not  be  retained. 
Food  had  to  be  administered  in  very  small 
quantities.  The  constipation  and  diarrhoea  al- 
ternated, but  the  stools  at  no  time  presented 
evidence  of  rectal  stricture.  The  urine  was 
normal — no  oedema — no  rise  of  temperature. 
During  the  last  nine  days  of  his  life  he  had  117 
grains  of  morphia  hypodermically,  in  one 
twenty-four  houi-s  getting  as  much  as  20  grains. 
He  died  quietly,  being  semi-conscious  for  six 
hours. 

The  autopsy,  26  hours  after  death,  was  neces. 
sarily  partial  and  hurried,  the  abdominal  and 
pelvic  viscera  being  the  only  parts  examined. 
A  scirrhous  tumour  was  found  involving  the  ter- 
mination of  the  sigmoid  flexure  and  upper  part 
of  the  rectum.  It  chiefly  affected  the  posterior 
part  of  the  bowel,  and  had  dense  adhesions  to 
the  posterior  wall  of  the  pelvis.  There  was  but 
slight  narrowing  of  the  gut.  The  peritoneum 
around  was  injected,  and  the  abdominal  and 
pelvic  glands  enlarged.  Liver,  spleen,  stomach, 
and  small  intestines  normal.  The  right  kid- 
ney was  congested,  small,  and  cortical  portion 
much  atrophied,  surface  smooth.  Left  kidney 
congested  and  enlarged.  The  right  supra-renal 
capsule  normal.  Left  supra-renal  capsule  much 
enlai'ged,  and,  though  softer,  similar  in  gross 
appearance  to  the  tumour  of  the  bowel.  Micro- 
scopical examination  showed  the  tumours  to  be 
of  a  carcinomatous  nature,  the  one  in  the 
bowel  having  much  more  of  the  fibrous  element 
than   that   of  the   supra-renal    capsale,  which 


was  softer  and  much  richer  in  cells.  From 
the  rather  meagre  literature  of  cancer,  of  the 
supra-renal  capsule,  I  have  learned,  that  it  is 
rarely  found  primary,  one-sided,  or  occurring  in 
young  subjects.  Also  in  all  diseases  confined 
to  these  structures,  the  body  is  usually 
not  emaciated.  These  facts,  together  with 
the  microscopic  appearances  and  relative  sizes 
of  the  growths,  point  to  the  pelvis  as  the 
primary  seat  of  the  disease.  It  is  worthy  of 
note,  that  many  of  the  symptoms  present,  in  this 
case,  while  under  my  observation  occur  in  both 
lead  poisoning  and  supra-renal  disease.  Of 
course  the  wrist  drop,  and  blue  line  on  gums 
observed  last  spring  were  distinctive.  They 
were  not  present  latterly,  and,  save  the  cachectic 
look  of  malignant  disease,  nothing  like  the 
bronzed  skin  of  Addison  was  noticed.  The 
lead  poisoning  was,  I  think,  neither  a  primary 
nor  concomitant  cause,  though  it  undoubtedly, 
by  increasing  the  anaemia,  may  have  hastened 
the  fatal  issue.  Pathologists  who  adopt  the  view 
that  cancer  is  exclusively  local  in  its  origin 
would  look  upon  the  constipation  of  lead  poison- 
ing as  liable  to  cause  cancer  of  the  rectum  ;  but 
I  am  not  aware  that  constipation  has  been 
noted  as  frequently  preceding  the  development 
of  malignant  disease  there. 


RUPTURE  OF  STOMACH. 

BY  JOHN  H,  m'cOLLUM,  M.B,,  TORONTO. 

A.  E.  F.  B ,  set  45.    Received  a  powerful 

blow  from  above  downwards  and  backwards 
from  a  heavy  piece  of  wood  which  was  thrown 
back  from  a  circular  saw  to  which  he  was  feed- 
ing it.  This  occurred  at  2.30  p.m.  of  the 
2nd  of  November.  He  was  rendered  uncon- 
scious for  a  short  time,  but  soon  recovered 
and  was  conveyed  to  his  house  in  a  wag- 
gon at  3.30.  He  was  able  to  walk,  being 
supported  on  either  side  from  the  waggon  to 
the  house  and  was  assisted  to  bed. 

He  complained  of  a  severe  pain  over  the  seat 
of  injury,  which  was  about  in  the  nipple  line 
over  the  cartilages  of  the  false  ribs  of  the  right" 
side.  There  was  a  slight  discolouration,  but  no 
abrasion  of  the  skin.  The  pain  was  localized 
in  this  spot.  There  had  been  no  vomiting ; 
full  respiration  caused  an  exacerbation  of  the 


392 


CANADIAN  JOURNAL 


paia  ;  there  was  no  crepitus,  and  but  slight  evi- 
dence of  shock ;  no  faintness,  pallor,  or  coldness, 
and  except  for  the  pain  there  was  no  alarming 
symptom.  He  was  ordered  opium.  At  about 
4.30  or  5  p.m.  the  first  dose  of  opium  was 
given,  this  he  vomited.  At  7  p.m.  was  seen 
again  ;  the  pain  was  increasing,  but  still  local- 
ized ;  as  he  had  vomited  the  first  dose  of  medi- 
cine, his  friends  had  neglected  to  give  him  any 
more.  A  hypodermic  of  morph.  sulph.  gr.  ^ 
was  given,  and  he  had  half  an  hour's  rest.  Hot 
fomentations  were  also  applied  over  the  seat  of 
pain.  At  10  p.m.,  as  he  desii-ed  to  pass  water, 
but  was  unable,  a  catheter  was  passed  and  about 
a  pint  of  noi"maI-looking  urine  withdrawn. 
The  pain  was  now  becoming  general,  extending 
over  the  abdomen  which  was  more  or  less  dis- 
tended. The  pain  was  aggravated  on  pressure. 
At  11  p.m.  the  pain  increased,  and  the  face 
began  to  assume  the  pinched  and  anxious  ap- 
pearance indicative  of  peritoneal  trouble;  the 
pulse  became  frequent  and  thready.  He  had 
since  7  p.m.  swallowed  a  ^  gr.  granule  of  morph. 
sulph.  every  hour  in  a  little  water  without 
relief;  also  some  bi'andy.  His  mind  was  clear 
up  to  the  last  moment,  when  be  sat  up  in  bed 
to  take  a  drink  of  water  and  fell  over  imme- 
diately, dead,  at  8  a.m.  of  the  3rd. 

Post-mortem  four  hours  after  death  ;  abdomen 
distended  ;  no  abrasion  of  skin  noticeable. 

Immediately  on  opening  the  peritoneum  a  gush 
of  intestinal  gas  escaped,  and  the  belly  flattened. 
The  intestines  were  in  appearance  slightly  in- 
jected, and  a  little  sticky  under  the  stomach. 
The  abdominal  cavity  contained  a  quantity  of 
thin  brownish  fluid,  and  bits  of  undigested  food 
were  floating  about ;  some  particles  were  found 
as  low  down  as  the  caecum.  The  stomach  was 
lying  under  the  diaphragm,  its  cardiac  extremity 
concealed,  but  the  body  distended  and  round ; 
the  pyloric  orifice  being  to  the  right  side  of  the 
spine,  and  under  the  left  lobe  of  the  liver.  Over 
the  vertebral  column  and  beginning  an  inch  and 
a  half  from  the  pyloric  orifice  was  a  rent  on  the 
anterior  wall  of  the  stomach,  and  extending  to 
the  pylorus  ;  the  rent  was  about  an  inch  and  a 
half  in  length,  the  edges  strongly  everted,  the 
gastric  mucous  membrane  projectingand everted; 
a  mass  of  cabbage  was  protruding  from  this 
orifice.     There  was  some   blood  eflfused  under 


the  serous  covering  of  the  stomach,  and  this 
extended  under  the  serous  covering  of  the 
duodenum  for  some  three  or  four  inches.  The 
posterior  wall  of  the  stomach  immediately  op- 
posite to  the  rent  was  much  ecchymosed  for  a 
space  about  the  size  of  a  silver  dollar,  and  an 
abrasion  of  the  outer  coat  of  the  stomach 
reaching  to  the  muscular  layer  was  noted  at 
this  point. 

The  liver  presented  upon  the  upper  and  back 
portion  of  the  right  lobe  several  ecchymoscs ; 
and  the  colour  of  its  capsule  was  a  peculiar  livid 
blueish  gray.     Splscn  healthy. 

There  was  no  blood  free  in  the  abdominal 
cavity,  nor  were  the  abdominal  and  mesenteric 
veins  enlarged  or  dilated.  The  heart  was  not 
examined.     The  kidneys  were  healthy. 


CONGENITAL  MALFORMATION  OF 
RECTUM  AND  ANUS. 

BY  GEORGE  SHAW,  M.D.,  HAMILTON. 

Mrs.  O — ,  on  24th  August,  was  delivered  of 
a  large  healthy  child,  well  developed  excepting 
the  anus,  which  was  absent.  During  the  second 
and  following  days,  meconium  was  passed  with 
urine  in  small  quantities,  sufiicient  to  stain  the 
napkin.  No  rectal  pouch  was  noticeable,  nor 
could  any  sensation  be  detected  in  that  region. 
An  operation  was  pi"0  posed  but  not  consented 
lo  until  late  the  evening  of  third  day.  The 
following  morning  the  infant  was  chloroformed 
and  a  tentative  incision  to  the  depth  of  an 
inch  made  through  the  perinseum,  between 
bladder  and  coccyx,  with  negative  results. 
Colotomy  was  then  easily  performed  by  Dr. 
Malloch.  Meconium  freely  escaped  after  open- 
ing colon.  The  child  was  under  chloroform 
one  hour  and  forty-five  minutes;  recovered 
well  from  the  operation ;  nursed  freely  several 
times  and  seemed  doing  well,  until  the  next 
morning  when  unfavourable  symptoms  appear- 
ed, the  child  dying  the  same  evening,  the  fifth 
after  birth.  A  post  mortem  made  the  next  day 
revealed  the  fact  that  death  resulted  from 
peritonitis.  No  meconium  was  found  in  the 
abdomen.  The  colon  terminated  in  a  large 
dilatation  running  well  into  the  hollow  of  the 
sacrum,  its  fibres  interlacing  with  those  of  the 
bladder.     The   rectum   and   bladder  were  re- 


OF  MEDICAL  SCIENCE. 


393 


moved,  and  on  closer  examination  it  was  noticed 
that  the  rectum  communicated  with  the  bladder 
at  the  trigone  vesicale  by  a  small  opening  not 
more  than  one-sixteenth  of  an  inch  in  diameter. 
It  might  be  stated  that  the  sister  of  Mrs.  O — , 
was  delivered  of  a  still-born  child  with  no  anus, 
besides  having  had  another  child  with  congenital 
deformities. 


MEYER  ON  PAINFCJL  PRESSURE- 
POINTS. 

Dr.  Moritz  Meyer  (Berlin.  Klin.  Woch., 
No.  31,  1881  has  already  called  attention  {ibid., 
No.  51,  1875)  to  the  indications  for  galvanic 
treatment  obtained  from  the  presence  of  painful 
pressure-spots  along  the  spine.  In  the  present 
paper,  he  re-states  and  illustrates  this  poiut,  and 
extends  his  statement  to  pressure-spots  discover- 
able along  the  whole  course  of  the  trunks  and 
branches  of  nerves. 

The  first  case  adduced  is  that  of  no  less  a 
patient  than  Professor  Westphal  himself,  who, 
in  May,  1880,  had  an  attack  of  neuralgia  in  the 
right  arm  and  shoulder.  Dr  Meyer  discovered 
a  painful  pressure-point  at  the  upper  part  of 
the  brachial  plexus.  An  anode  of  ten  cells  was 
applied  to  it,  and  within  five  minutes  the  pain 
had  considerably  subsided.  The  repetition  of 
the  operation  four  times  during  the  ensuing 
week  was  sufiicient  to  eftect  a  complete  cure. 
In  the  next  two  cases,  the  result  of  the  treat- 
ment is  the  more  striking,  tliat  previously  the 
patients  had  been  subjected  to  galvanic  treat- 
ment on  the  usual  system. 

A  girl,  aged  fourteen,  had  for  the  last  nine 
months  sufiered  from  severe  pains  in  the  fourth 
interosseous  space  of  the  right  hand,  extending 
upwards  along  the  radial  nerve,  to  the  posterior 
edge  of  the  deltoid.  Most  movements  of  the 
arm  had  become  impossible.  The  galvanic 
current  had  been  applied  to  the  hand  and 
forearm  during  several  weeks.  Dr.  Meyer 
discovered  a  limited  tender  spot  in  the  bi*achial 
plexus.  The  anode  was  applied  over  it,  with 
the  immediate  result  of  enabling  the  patient  to 
write  a  few  words.  Every  successive  applica- 
tion determined  further  progress ;  and,  after  the 


seventeenth,  the  patient  was  considered  well. 
Subsequently,  after  excessive  writing,  there  was 
a  slight  relapse,  which  rapidly  gave  way  to  the 
same  treatment. 

Another  patient  aged  nineteen,  in  conse- 
quence of  an  injury  to  the  head  of  the  ulna,  for 
which  she  had  worn  a  plaster  bandage  for  six 
weeks,  had,  during  two  years,  suffered  from 
neuralgia  in  the  ulnar  nerve,  which  deprived 
her  of  the  use  of  the  arm.  Every  kind  of 
treatment,  including  galvanism  locally  applied, 
had  failed  to  give  any  relief.  A  tender  spot 
was  found  at  the  lower  part  of  the  brachial 
plexus ;  and  the  treatment  was  accordingly 
conducted  as  in  the  previous  case.  Very  soon 
the  pain  diminished,  and  the  patient  began  to 
be  able  to  extend  and  abduct  the  little  finger. 
After  twenty  applications,  she  was  able  to  paint, 
play  the  piano,  etc.  Writing  was  still  difficult, 
and  the  treatment  was  persevered  in  for  another 
series  of  thirty  applications,  when  she  had 
practically  recovered. 

The  following  cases  illustrate  the  indicative 
importance  of  pressure-points  for  galvanic 
treatment  in  other  neuroses. 

A  patient  aged  twenty-seven,  had  suffered  for 
nine  years,  from  sick  headache.  The  attacks 
were  very  frequent,  chiefly  in  the  left  side. 
There  was  tenderness  over  the  upper  cervical 
transverse  processes.  The  positive  pole,  of  six 
elements,  was  applied  to  the  corresponding  side, 
for  three  minutes.  Thirty-five  such  applications, 
spread  over  three  months,  relieved  her  complete- 
ly. A  slight  relapse,  after  undue  excitement 
and  exertion,  was  overcome  by  a  repetition  of 
the  treatment.  Thero  has  been  no  relapse  for 
the  last  four  years. 

A  banker,  aged  thirty,  became  affected  with 
twitching  on  the  right  side  of  the  face.  Pressure 
on  the  third  and  fourth  cervical  transverse  pro- 
cesses was  painful,  and  arrested  the  twitching. 
Two  courses  of  anodal  galvanisation  of  the  spots, 
successfully  relieved  the  patient,  who  has  been 
free  from  any  symptom  for  the  last  twelve 
months. 

In  a  third  patient  a  fall  downstairs,  two 
years  previously,  produced  injury  to  the  right 
scapular  region  ;  this  was  followed  by  a  neural- 
gic condition  of  the  shoulder  and  arm,  with 
difficulty  of  breathing.     Dr.  Meyer  found  the 


394 


CANADIAN  JOURNAL 


motor  points  of  the  rhomboid  (which  was  in  a 
stale  of  contraction)  and  the  serratua  magnus 
painful.  Rapid  recovery  took  place  under 
galvanisation  of  these  points. 

Dr.  W.,  aged  forty,  after  a  strain  six  years 
ago,  lost  power  in  the  left  arm,  and  experienced 
a  sense  of  tightness  in  the  left  side  of  the  thorax. 
He  had  been  thi'ough  a  number  of  methods  of 
treatment,  external  and  internal,  but  without 
benefit.  Two  painful  points  were  found  :  one 
over  the  seventh  cervical  spinous  process,  pres- 
sure upon  which  caused  violent  hiccoughing;  the 
other  over  the  origin  of  the  left  phrenic  nerve, 
form  the  third  to  the  fifth  left  transverse  pro- 
cesses. A  short  galvanic  treatment  of  nine 
sittings  of  these  spots  brought  about  a  marked 
improvement.  Nothing  remained,  on  the 
patient's  compulsory  departure  from  Berlin, 
beyond  a  vague  sense  of  discomfort.  Later 
news  from  the  patient  showed  the  improvement 
to  be  lasting. 

On  the  strength  of  these  and  many  other 
cases,  the  author  insists  on  the  necessity  of 
carefully  searching  in  all  cases  of  obstinate 
neuroses  for  painful  spots.  Weak  currents  are 
indicated  especially  at  first. — London  Medical 
Record. 


MALARIAL  FEVERS    AND  SULPHUR- 
OUS EMANATIONS. 

(Translated  from  Le  Journal  D' Hygiene,  by  Dr. 
P.  H.  Bryce,  M.A.) 

M.  d'Abbadie,  the  learned  traveller,  has 
given  an  account  to  the  Academy  of  Science  of 
an  enquiry  carefully  made  for  determining 
"  whether  the  sulphurous  emanations  involun- 
tarily received  in  those  places  where  malaria 
reigns  are  of  a  nature  to  preserve  the  health  of 
their  inhabitants  1 " 

From  statements  which  have  been  trans- 
mitted to  him  by  M.  le  Pr.  Silrestri  of  Catana, 
it  appears  "that  the  great  portion  of  the  sou- 
frih'es  (sulphur  works)  of  Sicily  are  situated 
in  mountainous  localities  where  the  influence 
of  malaria  is  not  felt.  However,  some  sou- 
frieres  are  found  in  a  region  but  slightly 
elevated  in  places  where  intermittent  fevers 
prevail.  In  these  districts,  while  the  popula- 
tion of  neighbouring  villages  are  attacked  by 


the  fever,  in  the  proportion  of  90  per  cent.,  the 
workers  in  the  sulphur  mines,  without  being 
j>erfectly  exempt  from  the  scourge,  only  suffer 
from  it  in  the  proportion  of  8  or  9  per  cent. 

These  figures  confirm  the  opinion  so  gener- 
ally admitted  in  Ethiopia  of  the  efficacy  of 
sulphurous  fumigations. 

On  the  other  hand,  M.  le.  Dr.  Fonqu^,  who 
has  related  the  fortunes  of  the  great  city  of 
Zephyria  (40,000  souls),  situated  at  the  base  of 
the  road  of  Milo,  a  city  completely  decimated 
by  paludal  fevers,  attributes  this  decadence 
and  ruin  to  the  removal  of  the  sulphur  works. 
This  removal  of  the  soufrieres  has  varied  in 
former  times.  Until  the  end  of  the  last  cen- 
tury the  sulphur  was  principally  mined  at 
KaUmo,  since  this  time  it  has  mostly  been  on 
the  eastern  side  of  the  island. 

"  In  a  word,"  writes  M.  Fonqu^,  "  Zephyria 
and  the  surrounding  plain  have  become  de- 
serted since  they  are  no  longer  subjected  to 
sulphurous  emanations.  This  coincidence  is  in 
all  cases  worthy  of  attention." 

Another  example :  The  marshy  plain  of 
Catana  is  traversed  by  the  Simeto,  and  is 
infested  with  fevers.  On  the  west  side  of  this 
plain  is  a  soufriere,  and  beyond  it  is  still  seen 
a  village  which  was  abandoned  at  the  com- 
mencement of  our  century,  on  account  of  inter- 
mittent fevers.  It  is  proper  to  note  that 
the  district  of  the  sulphur  works  is  peopled  by 
a  colony  of  workers,  while  the  village  is 
deserted,  although  it  occupies  a  more  elevated 
position.  The  sulphurous  emanations  would 
then  seem  to  exercise  a  favorable  influence. 

It  has  appeared  to  me  necessary  to  give 
this  communication  of  M.  d'Abbadie  great 
publicity  in  order  to  call  for  the  examination 
of  these  facts,  and  their  clinical  control  by  our 
learned  confreres  in  Sicily.  Dr.  J.  M.  C. 


CoNVALLARiA  Majalis. — Further  testimony 
in  favour  of  the  value  of  the  Lily  of  the  Valley 
(infusion  of  seeds,  stem,  and  roots — eight  oz. 
bruised,  to  the  pound  of  boiling  water — 
of  which  a  dose  is  two  oz.  every  two  hours),  as 
a  cardice  tonic  and  sedative,  and  valuable  suc- 
cedaneum  of  digitalis,  are  contributed  by  Dr. 
H.  C.  Wood  to  the  Phila.  Med.  Times. 


OF  MEDICAL  SCIENCE. 


395 


NEW   TESTS   FOR   ALBUMEN    IN 
URINE. 

Dr.  Wm.  Roberts,  of  Manchester — one  of 
the  highest  living  authox'ities  on  the  subject — 
lately  recommended  the  following  in  the 
London  Lancet :  "In  preparing  the  test  with 
our  common  English  measures,  the  readiest 
plan  is  to  mix  a  fluid  ounce  of  dilute  hydro- 
chloric acid  with  a  pint  of  water,  and  to 
saturate  this  with  common  salt,  and  filter." 
(An  equal  quantity  of  dilute  nitric,  sulphui-ic  or 
phosphoric  acid  may  be  used  instead  of  the 
hydrochloric.)  The  method  of  applying  the 
brine  test  is  similar  to  that  followed  with  nitric 
acid.  A  portion  of  the  suspected  urine  is  placed 
in  a  test  tube,  the  test-tube  is  then  held  very 
much  aslant,  and  the  salt  solution  is  allowed 
to  trickle  along  the  side  of  the  tube  to  the 
bottom,  so  that  it  may  form  a  distinct  layer  at 
the  bottom.  If  albumen  be  present,  a  white 
cloudy  zone  appears  at  the  junction  of  the  two 
fluids."  The  precipitation  is  not  due  to  a  true 
coagulation,  hence  it  is  re-dissolved  by  the  free 
addition  of  water  or  even  of  the  urine  itself. 
In  point  of  delicacy,  the  brine  test  stands  on  a 
par  with  nitric  acid.  In  high-coloured  urines 
it  is  superior,  causing  neither  a  deepening  of 
the  tint  nor  the  disengagement  of  gas,  as  does 
nitric  acid.  Acidulated  brine  also  precipitates 
peptones  in  urine,  giving  rise  to  a  slight  cloudi- 
ness sometimes  where  nitric  acid  and  heat 
produce  no  reaction.  This  test  for  peptones 
may  prove  of  clinical  value  in  the  future.  The 
brine  does  not  precipitate  the  urates  as  does 
nitric  acid  in  dense  urines.  The  cloudiness 
produced  by  nitric  acid  in  resinous  urines  in 
the  cold,  also  occurs  with  the  brine  whether  hot 
or  cold.  Cloudiness  occurring  with  the  salt 
solution,  if  due  to  albumen,  disappears  on  the 
addition  of  a  large  excess  of  the  urine,  but  not 
so  if  due  to  the  presence  of  resins.  One 
advantage  of  the  salt  solution  is  its  being 
incorrosive  and  hence  safe  in  carriage.  Another 
is  that  it  does  not  interfere  with  the  test  for 
sugar.  The  same  specimen  after  being  thus 
tested  for  albumen,  may  by  the  addition  of 
Fehling's  solution,  or  one  of  Cooper's  pellets  of 
the  solid  Fehling's  test  be  examined  for  sugar. 

Dr.    Geo.   Johnson,  of  King's  College,  in   a 


more  recent  communication,  suggests  a  satur- 
ated solution  of  picric  acid,  or  a  few  crystals 
of  that  acid,  as  an  extremely  delicate  and 
satisfactory  test  for  albumen  in  urine. 

Dewar  on  Ergot  in  Pertussis. — Dr.  John 
Dewar,  in  the  Practitioner,  May  1882,  p.  358, 
draws  attention  to  the  great  value  of  the  liquid 
extract  of  ergot  in  whooping  cough,  in  which 
disease  he  believes  it  to  be  the  bestand  safest, 
of  all  remedies.  [In  the  Edinburgh  Med  Jour., 
1863,  Dr.  Griefenkel  reported  the  case  of  a  lad, 
six  years  old,  who  was  cured  of  whooping  cough 
in  eight  days,  [Vide  Med.  Digest,  sec.  715,  4.) 
During  the  last  week,  in  the  reporter's  practice, 
a  child  of  eighteen  months,  not  progressing  well 
under  the  belladonna  treatment,  was  vastly 
relieved  after  a  few  5 -minim  doses  of  Battley's 
liquid  extract  of  ergot. — Rep.^ — London  Medi- 
cal Record. 


Tubercle  Antidote — M.  de  Korab  asserts 
that  he  has  found  the  employment  of  helenine 
to  be  inimical  to  the  development  of  the  bacilli 
of  tuberculosis. 

GOSSYPIUM  MEDICATUM. 

Gossypium  Hcemostaticum :  —  Solution  of 
chloride  of  ii'on,  2  parts;  distilled  water,  12; 
potash  alum,  1  ;  purified  cotton,  q,  s.  Dissolve 
the  alum  in  the  water,  add  the  chloride  of  iron, 
and  soak  a  sufficient  quantity  of  purified  cotton 
in  the  mixture.  Dry  it  at  a  temperature  below 
60°  C.  (140°  Fah.).  Pick,  and  preserve  in  a 
well-stopped  bottle  with  a  wide  mouth. 

Gossypium  Hoimostaticum,  et  Antisepticum : 
— Tannic  acid,  5  ;  carbolic  acid,  4  ;  alcohol,  50 ; 
purified  cotton,  q.  s.  Dissolve  the  acids  in  the 
alcohol  and  treat  as  befox^e. — -New  Remedies. 

Gossypium  Boracicum  : — Boracic  acid,  10 
parts;  water,  90;  purified  cotton,  q.  s.  Saturate, 
press,  and  dry  as  before. 

Gossypium  Salicylicum  : — Salicylic  acid,  10 
parts;  strong  spirits,  100;  glycerine  1;  purified 
cotton,  100.  Dissolve  the  acid  in  the  alcohol. 
Saturate,  press,  and  dry,  and  keep  as  before. 

Gossypium  lodoformum: — Iodoform,  2  parts; 


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CANADIAN  JOURNAL 


ether,  10  ;  strong  alcohol,  20 ;  glycerine,  10  ; 
purified  cotton  wool,  30.  Dissolve  the  iodo- 
form in  the  ether  and  alcohol  mixed  ;  add  the 
glycerine  and  then  saturate  the  cotton  wool  ; 
dry  by  exposure  to  the  open  air,  and  keep  in  a 
glass-stoppered  bottle. 

Gossypium  PuHJicatum : — Macerate  the  com- 
mercial cotton  wool  for  the  space  of  ten  minutes 
in  benzol,  press  out  the  liquid,  and  allow  the 
wool  to  dry  by  exposure  to  the  air. —  Monthly 
Magazine. 

IODOFORM  IN  EYE  DISEASES. 

liieber  uses  iodoform  in  vaseline  1  to  10,  and 
finds  it  very  useful  in  strumous  inflammations. 
In  acute  inflammations  most  eyes  bear  only  a 
very  small  quantity  of  iodoform  j  in  other 
cases  it  is  generally  well  borne.  Iodoform 
shows  its  superior  action  in  fresh  wounds  of 
the  globe  of  the  eye,  alike  from  accident  or 
operation.  In  scleritis  and  episcleritis  it  is  of 
no  use  j  whilst  in  ulcus  cornese  serpens  it  is 
almost  a  specific. 

Grossman  finds  that  iodoform  is  specially 
useful  in  the  abundant  purulent  discharge  of 
gonorrhoeil  ophthalmia,  and  in  ophthalmia 
neonatorum. 

Fischer  remarks  :  1.  That  it  is  well  borne  by 
most  diseased  eyes.  2.  Ic  is  the  most  success- 
ful remedy  in  pannus  scrofulosus  and  tracho- 
matosus.  3.  As  an  antiseptic,  it  is  of  service 
in  operations.  4.  It  hastens  the  formation  of 
healthy  granulations,  and  the  regeneration  of 
corneal  epithelium.  5.  It  is  of  considerable 
worth  in  dacryocystitis. — (Wien.  Med.  Woch.) 


The  Temporary  Treatment  of  Dental 
Caries. — It  often  happens  that  physicians  are 
called  upon  to  put  an  end  to  the  intense  sufier- 
ing  occasioned  by  diseased  teeth,  the  services  of 
a  dental  practitioner  not  being  at  command. 
Failing  to  allay  the  pain,  or  perhaps  declining  to 
undertake  what  seems  the  hopeless  task,  the 
physician  is  apt  to  yield  to  the  patient's  impor- 
tunities, and  extract  the  offending  tooth  ;  thus 
many  teeth  that  might  be  reclaimed  are  sacri- 
ficed. How  to  avoid  this  loss,  and  yet  give  re- 
lief, is  set  forth  by  Dr.  Shirley  Deakin  in  the 
July  number  of  the  Indian  Medical  Gazette. 


Suppose  a  patient  to  be  suffering  from  caries  of 
a  tooth,  connected  with  abscess  of  the  gum, 
capable  of  opening  his  mouth  only  a  short 
distance,  on  account  of  swelling  of  the  side  of 
the  face ;  and  to  have  passed  sleepless  nights, 
in  spite  of  having  applied  creasote,  carl)olic 
acid,  chloroform,  etc.,  without  much  effect, 
beyond  cauterizing  his  gums.  The  tooth  being 
found  to  have  a  strong  shell,  the  patient  is 
directed  to  rinse  his  mouth  well  with  tepid 
water  (water  of  the  temperature  he  finds  most 
agreeable).  After  drying  the  mouth,  absorbent 
cotton,  either  in  pledgets  or  twisted  into  a  rope, 
is  introduced  around  the  tooth,  so  as  to  separ- 
ate it  from  the  tongue  and  the  cheek.  The 
cavity  is  then  to  be  cleaned  and  dried  out,  as 
thoroughly  as  the  tenderness  will  allow  of,  by 
means  of  a  bent  probe  with  some  absorbent 
cotton  twisted  round  its  end.  In  this  part  of 
the  procedure  the  great  point  is  to  keep  the 
tooth  cavity  free  from  saliva,  and  thoroughly 
dry.  The  cavity  is  now  to  be  filled  with  a 
cotton  pellet  saturated  with  the  following 
mixture  : — 

R  Pure  phenol  (carbolic acid  No.  l...f  §8S. 

Glycerin    n\^xx. 

Tannic  acid 3VJ- 

M. 

Instead  of  this  precise  quantity  of  tannic  acid, 
as  much  of  it  may  be  used  as  the  carbolic-acid 
solution  will  take  up,  adding  it  slowly,  forming 
a  molasses-like  liquid,  the  action  of  which,  the 
author  says,  is  quite  different  from  that  of 
either  of  the  chief  ingredients  used  separately. 
The  application  is  painless,  and  it  quickly  des- 
iccates the  pulp,  rendering  it  perfectly  insensi- 
ble, without  appearing  to  permeate  the  sur- 
rounding healthy  dentine  to  any  great  extent. 
A  piece  of  cotton  soaked  in  a  solution  of 
mastich  or  gum  benzoin  in  ether  is  applied 
over  the  pheno-tannic  pellet,  to  protect  it  from 
the  action  of  the  saliva.  The  pledgets  of 
cotton  are  now  removed  from  about  the  tooth, 
and  the  mouth  is  well  rinsed  with  water. 
Should  there  be  any  subsequent  tenderness,  the 
plug  may  be  changed,  two  or  three  times  a  day 
at  first,  and  then  once  in  two  or  three  days, 
until  the  inflammatory  action  has  subsided. 
Often  but  one  application  is  needed.  As  soon 
aa  the  patient  can  bear  the  necessary  manipula- 


OF  MEDICAL  SCIENCE. 


39; 


tion  the  cavity  is  to  be  cleaned  out  thoroughly 
and  stopped  witli  oxychloride  of  zinc  (o»  arti- 
Jiciel).  The  author  has  known  this  filling  to 
remain  servicable  for  three  or  four  years. — 
iV.  Y.  Med.  Jour. 


Treatment  of  Sequelae  of  Frostbites. — 
The  editor  of  the  Philadelphia  Medical  and 
Surgical  Reporter,  after  referring  to  a  remedy, 
recommended  by  Or.  Lapatin,  of  Tiflis,  consist- 
ing in  the  application,  by  a  glass  brush,  of  a 
mixture  of  equal  parts  of  dilute  nitric  acid  and 
aqua  menthse  (Rust's  Frozing-Wash  contained 
aq.  cinnamomi  instead  of  menthae)  says  : — We 
know,  from  our  own  experience,  however,  a 
far  better,  quicker,  and  still  more  reliable 
remedy,  which  we  have  never  known  to  fail, 
no  matter  how  much  the  parts  may  have  been 
inflamed,  if  only  mortification  had  not  set  in, 
and  this  is  copaiba  balsam.  The  same  is 
thickly  spread  on  a  piece  of  linen  or  muslin^ 
and  the  afiected  parts  covered  with  it  during 
the  night,  and  a  stockina:  put  over  the  whole. 
In  daytime  simply  some  of  the  balsam  is 
spread  over  the  parts.  After  one,  or  at  most 
two  applications,  the  redness  and  all  pains 
cease,  and  a  few  more  applications  do  not  only 
remove  every  residue  of  it,  but  they  seem  to 
impart  a  remarkably  increased  vital  resistance 
to  the  parts  against  frostbite,  if  only  .common 
precautions  are  used. 

Circumcision. — Dr  Skillem,  of  Philadelphia, 
has  invented  a  new  forceps  which  has  many 
advantages  in  circumcision,  and  the  use  of  it  is 
so  simple  that  the  operation  can  be  preformed 
rapidly  and  without  assistance.  The  forceps 
are  cx'oss  branched,  opening  by  pressure  and 
self-closing.  The  blades  are  fenestrated  through 
their  entire  length.  The  prepuce  having  been 
drawn  well  forward,  the  forceps  are  applied. 
A  threaded  needle  is  then  passed  through  the 
fenestra  and  included  prepuce  making  as  many 
stitches  as  are  necessary,  but  leaving  the  thread 
long  and  loose.  The  prepuce  is  then  cut  ofi" 
close  up  to  the  forceps.  The  thread  is  divided 
both  between  each  stitch  and  between  the  two 
edges  of  the  prepuce,  thus  giving  as  many 
threads  as  may  be  desired.  By  drawing  each  of 
these  together  the  mucous  and  skin  surface  can 
be  accurately  approximated. — Chicago  Medical 
Journal. 


Entropion. — Bbckman,  in  the  Wien  Med. 
Woch.  gives  the  following  operation  for  en- 
tropion :  A  thread  is  passed  through  two 
needles — these  ai'e  put  into  a  needle-holder 
about  1  or  2  n)^TT|^.  apart.  The  needles  are  en- 
tered on  the  conjunctival  side  of  the  lid,  be 
yond  the  edge  of  the  cartilage,  carrii^d  along 
between  the  tarsal  cartilage  and  skin,  and 
made  to  emerge  near  the  free  edge  of  the  lid- 
The  ends  of  the  thread  are  then  firmly  tied  and 
the  skin  drawn  so  as  to  make  the  lid  slightly 
ectropic.  Two  or  more  such  sutures  may  be 
put  in.  The  operation  is  very  pimple,  and 
spoken  of  as  quite  successful.  The  threads  are 
separated  by  ulceration,  and  the  lid  is  fixed  in 
its  proper  position  by  the  adhesive  inflamma- 
tion set  up. 

FissuRA  Ani. — Demure, in  Wien.  Med.  Woch., 
records  the  case  of  a  child,  eight  days  old,  with 
a  very  long  and  deep  fissure  of  the  anus.  It 
caused  great  pain,  and  bled  freely  each  time  the 
bowels  were  moved.  The  irritation  from  the 
fissure  produced  chorea.  The  sore  was  dried 
carefully  and  painted  freely  with  a  mixture  of 
1  part  iodoform,  4  parts  balsam  of  tolu,  and  20 
parts  ether.  The  ether  evaporates  and  leaves 
the  tolu  as  an  insoluble  varnish  containing  the 
iodoform.  Complete  recovery  took  place  in 
eleven  days. 

Prof.  Kaposi  has  used  naphthol   with  great 

success  in  many  varieties  of  skin  diseases.    For 

animal  and  vegetable  parasites  he  recommends 

the  following  ointment : 

Axungiae TOO 

Sapon.  viridis 50 

Naphthol 15 

Cretae  Alb.  pulv 10 

In  the  inflammatory  afi'ections  of  the  skin  he 

prefers  a  solution  varying  from   1    to   15  per 

cent  in  alcohol.     He  has  used  naphthol  in  710 

cases,  of  which   71  were  eczema ;  33   prurigo ; 

37  psoriasis.     The  remainder  were  principally 

parasitical. — (Wien.  Med.  Woch.) 


Dr.  E.  L.  Duer,  (Phila.  Med.  Times)  recom- 
mends erigeron  or  fleabane,  used  internally,  to 
stop  hemorrohage.  The  oil  may  be  given  in 
ten  drop  doses  every  ten  minutes  till  bleeding 
is  checked.  Continued  afterwards  at  longer 
intervals. 


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CANADIAN  JOURNAL 


<S;0mjSi)ron4rniri. 


To  the  Editor  of  the  Canadian  Journal  of  Uidical  Scibnoi 

"ROUGH  ON  RATS." 

Dear  Sib, — Lately  there  occurred  in  this  city 
two  cases  of  poisoning  by  the  use  of  the  sub- 
stance sold  under  the  title  of  "  Rough  on 
Rats."  One  of  these  cases  proved  fatal.  As 
the  deadly  nature  of  this  substance  is  not  gen- 
erally known,  I  enclose  a  report  of  the  analysis 
of  the  contents  of  the  box  used  in  one  case.  It 
is  not  right  that  arsenic  should  be  so  easily 
procurable  by  unknown  parties. 

Althou'h  I  cannot  think  that  my  patient 
swallowed  much  of  the  poison,  notwithstanding 
statements  by  herself  and  others  to  the  con- 
trary, I  was  unable  to  obtain  any  information 
at  three  drug  stores  as  to  its  composition.  For- 
tunately the  almost  immediate  use  of  emetics 
ad  lib.  was  followed  by  results  satisfactory  to 
myself  if  not  to  the  patient. 

R.  Zimmerman,  M.D. 

Laboratory,  116  King  West, 

November,  8th,  1882. 
I  have  made  an  examination  of  the  powder 
called  "  Rough  on  Rats,"  and  find  it  consists  of 
white  arsenic  (Asj  O,)  coloured  with  a  little 
charcoal.  The  amount  of  arsenic  is  over  99 
per  cent.  This  is  a  convenient  preparation  by 
which  anyone  can  obtain  a  powerful  poison. 
Yours  truly,  Thos.  Heys,  An.  Ch. 


THE  CANADIAN 


The    Board    of    Health    Map    and    the 

"  Lancet."— Several  persons  have  spoken  to  us 
about  the  unjust  criticisms  of  the  Lancet  on  this 
subject.  The  N.  Y.  Medical  Record  said  the  map 
was  the  best  thing  of  the  kind  that  had  been 
Issued.  Disinterested  persons  to  whom  we 
have  shown  it  and  the  slips  issued  by  the 
Michigan  Board,  such  as  the  Lancet  recom- 
mends, uniformly  declare  in  favor  of  the  map, 
as  attracting  more  attention,  and  better  serving 
to  fix  the  information  in  the  mind.  As  to  cost, 
we  learn,  on  enquiry,  that  the  map  plan  costs 
between  $50  and  $75  more  per  annum  than  the 
other.  "We  certainly  believe  in  paying  the 
Reporters  of  Statistics,  but  of  what  use  would 
this  sum  be  divided  among  the  many  ?  The 
Lancet's  spleen  is  seemingly  not  yet  frothed 
out. 


|BMriiii(  of  ||fliriij  |rifiirf, 

A  Monthly  Jonrnal  of  Medical  Science,  Criticism, 
and  News 

To  Correspondents.—  IVe  shall  be  glad  to  re- 
ceive from  our  friends  everywhere,  current  meaical 
news  oj  s^eneral  interest.  Secretaries  of  County 
or  Territorial  medical  associations  will  oblige  by 
forwarding  reports  of  the  proceedings  of  their 
Associations. 


TORONTO,  DECEMBER,  1882. 

THE  UNION  OF  THE  TORONTO 
SCHOOLS. 

The  old  question  of  the  Consolidation  of  the 
two  Schools  in  this  city  has  been  revived  by 
the  reading  of  Mr.  Carlton's  paper  on  the  sub- 
ject at  a  recent  meeting  of  the  Toronto  School 
of  Medicine  Medical  Society.  Since  that  time 
the  question  has  been  rather  extensively  dis- 
cussed, both  in  the  lay  press  and  at  the  Toronto 
School  of  Medicine  dinner,  but,  as  a  rule,  in 
such  a  vagueand  unsatisfactory  way  thatnothing 
definite  or  tangible  has  yet  come  to  the  surface. 

In  considering  the  subject,  two  questions 
naturally  arise  :  1.  Is  such  a  union  advisable? 
2.  Is  it  feasible  1  The  answer  to  the  first  de- 
pends largely  upon  the  connection  which  such 
an  institution  would  have  with  the  General  Hos- 
pital, ir  nearly  the  same  relations  should  exist 
as  now,  we  say  decidedly  the  union  would  not 
be  beneficial  to  either  the  profession  or  the 
public.  There  can  be  no  doubt  that  the  rivalry 
which  now  exists  between  the  schools  does 
stimulate  them  both,  and,  as  a  consequence,  they 
are  more  successful,  have  larger  classes,  do  more 
work  in  nearly  all  the  departments,  and  give 
better  satisfaction  than  we  have  ever  before 
seen  in  Toronto.  In  fact,  the  "signs  of  the 
times "  are,  that  Toronto  is  going  to  be  the 
leading  city  in  the  Dominion  in  things  medical, 
as  she  long  has  been  in  all  the  other  professions, 
(and  among  the  professions  we  include  the 
teaching  in  all  our  colleges  and  schools). 

On  the  other  hand,  if  a  union  could  result  in 
a  hospital  school  properly  managed,  we  can  say 
just  as  decidedly  that  such  a  consummation 
would  be  vastly  beneficial   on  account  of  the 


OF  MEDICAL  SCIENCE. 


399 


great  increase  in  the  advantages  for  clinical 
teaching  which  would  accrue. 

The  second  question — is  it  feasible? — is  more 
difficult  to  answer,  and  so  far  as  we  have  seen  or 
heard,  no  one  has  given  a  very  definite  reply. 
And  yet  we  hope  the  difficulties  in  the  way  are 
not  so  great  as  many  imagine.  It  may  simplify 
matters  to  propose  a  scheme  which  can  be  dis- 
cussed, and  we  subjoin  the  outlines  of  one  which 
would  be  quite  praclicable.  Let  a  new  Hospital 
Medical  School  be  established.  Let  the  Gov- 
ernment appoint  a  Governins;  Board  for  it,  com- 
posed of  a  certain  number  of  laymen  selected 
from  the  Senate  of  Toronto  University,  the 
CouncU  of  University  College,  the  Hospital 
Trust,  and  an  equal  number  of  physicians,  Let 
chairs  in  Physiology,  Anatomy,  and  Jurispru- 
dence, as  purely  scientific  subjects,  be  established 
in  University  College.  Physiology  and  Anatomy 
might  be  combined  and  taught  by  one  Professor, 
or  Physiology  might  be  included  under  Biology. 
We  could  thus  get  from  University  College  and 
the  School  of  Practical  Science  instruction  in 
Anatomy,  Physiology,  Toxicology,  Botany,  and 
Chemistry.  Let  the  lectures  on  purely  medical 
subjects  be  given  in  a  school  attached  to  the 
Hospital,  or  in  one  of  the  present  buildings,  and 
let  there  be  only  one  course  of  didactic  lectures 
given  on  each  subject.  Let  the  students  pay  in 
addition  to  their  present  hospital  fees  what  they 
now  pay  for  the  second  courses  in  Medicine, 
Surgery,  Midwifery, Materia  Medica,  and  Jui'is- 
prudence.  By  this  regulation  they  would  pay  $98 
each  to  the  Hospital,  instead  of  $44,  which  they 
now  give  for  perpetual  ticket  and  two  courses  of 
hospital  clinics.  Supposing  there  be  an  average 
attendance  of  100  new  students  each  year, 
which  is  considerably  less  than  the  two  schools 
have  together  had  during  each  of  the  last  two 
years,  there  would  be  a  revenue  of  about  ten 
thousand  dollars  a  year  from  this  source  alone. 
This,  after  deducting  a  reasonable  amount  for 
expenses,  would  leave  a  large  sum  to  be  ex- 
pended in  paying  a  competent  staff  of  clinical 
teachers. 

Let  there  be  in  the  hospital  a  regular  staff  of 
say  ten  attending  Physicians,  with  an  equal 
number  of  assistants,  arranged  in  a  manner 
somewhat  as  follows :  3  attached  to  Medicine, 
3  to  Surgery,  3  to  Midwifery,  Gynaecology  and 


Diseases  of  Children,  1  to  Eye  and  Ear.  Let 
each  have  an  assistant,  or,  to  accommodate  the 
present  arrangement,  let  the  two  Ophthalmolo- 
gists and  Aurists  be  coadjutors.  The  present 
arrangement  of  two  Pathologists  might  also 
answer.  It  should  be  the  duty  of  the  assistants 
to  attend  to  the  out-patients.  Let  the  members 
of  the  regular  staff  be  paid  three  or  four  times 
as  much  for  their  work  as  the  assistants  receive. 
Such  a  scheme  presents  no  great  obstacles, 
and  at  the  same  time  gives  ample  room  for  all 
the  good  men  in  both  schools,  whose  claims  we 
are  sure  no  one  would  desire  to  overlook  ;  and 
we  promulgate  it  without  any  firm  faith  in  a 
present  prospect  of  its  adoption,  but  merely  as 
a  forecast  of  the  lines  in  which  the  scientific 
teaching  of  medicine  in  this  city  in  the  future 
will  surely  run. 


DIRECTORY  FOR  NURSES. 

In  the  Canadian  Jour,  of  Medical  Science 
for  February,  1882,  appeared  an  article  urging 
the  advisability  and  the  propriety  of  establish- 
ing a  Directory  for  Nurses,  and  a  plan  was 
shadowed  forth,  by  which  this  might  be  effected. 
After  a  lengthened  period  of  incubation  the 
seed  then  sown  has  germinated,  mainly  owing 
to  the  indefatigable  efforts  of  one  man  and  his 
farseeing  sagacity,  and  has  blossomed  into  the 
Directory  for  Nurses,  which,  under  the  foster- 
ing care  of  the  To:  onto  Medical  Society,  will 
doubtless  bear  fruic  worthy  of  its  forebears. 

The  profession  and  the  good  people  of  Toronto 
already  owe  a  large  debt  of  gratitude  to  Dr. 
"Workman  for  his  many  and  beneficent  deeds 
performed  in  their  behalf,  and  not  the  least  of 
these  is  his  latest  in  urging  the  establishment 
of  the  Directory  for  Nurses. 

The  plan  of  the  Directory  is  modeled  after 
that  now  for  some  years  in  successful  operation 
in  Boston.  It  consists  in  gathering  information 
regarding  the  personal  and  professional  qualifi- 
cations of  nurses,  and  in  imparting  this  infor- 
mation to  those  in  need  of  it.  The  information 
is  gathered  from  three  sources  :  from  the  nurse 
and  from  the  physicians  and  families  to  whom 
reference  is  made.  As  a  check  to  this,  infor- 
mation is  elicited  by  a  system  of  enquiry 
directed  to  the  family  supplied  with  a  nurse  from 


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CANADIAN  JOURNAL 


the  Directory,  and  to  the  physician  in  charge  of 
the  CHse.  The  names  and  addresses  of  properly 
recommended  niirsos  ai-e  phiced  in  a  suitable 
register, and  the  confidential  information  elicited 
from  the  physicians  and  families  referred  to  is 
recorded  in  convenient  books  provided  for  this 
purpose. 

The  affairs  of  the  Directory  are  in  the  hands 
of  a  committee  apjx)inted  by  the  Toronto  Med- 
ical Society,  to  whom  the  committee  is  solely 
responsible.  The  books  are  kept  and  the 
informatioii  imparted  to  the  public  by  a  registrar 
appointed  by  the  committee.  And  here  Toronto 
necessarily  labours  at  a  disadvantage,  for  she 
has  no  Central  Medical  Institution  with  resident 
officers,  upon  whose  duties  could  be  engrafted 
those  of  the  registrar.  Tvo  courses  were  then 
open  to  the  committee,  either  to  find  a  Medical 
Practitioner  suitably  qualified,  who  would  be 
willing  to  assume  the  duties  of  the  office,  and 
thus  keep  the  management  of  the  Directory 
entirely  within  the  profession  ;  or  to  go  beyond 
the  professional  circle  ,and  find  some  layman 
jwssessing  the  necessary  requirements  of  acces- 
sibility, aptitude,  and  responsibility.  The 
Society  deemed  the  first  course  advisable,  and 
the  society,  the  profession,  and  the  public,  are 
to  be  congratulated  that  the  committee  have 
succeeded  in  prevailing  upon  Dr.  McPhedran 
to  assume  the  duties  of  this  position.  His  name 
is  a  guarantee  that  this  portion  of  the  work  of 
the  Directory,  will  be  executed  with  well  direct- 
ed zeal  and  painstaking  ability. 

Although  the  committee  require  that  nurses 
shall  be  well  recommended  by  competent  phy- 
sicians, and  that  their  references  shall  be  satis- 
factory ;  still,  nurses  of  average  or  infenor 
ability  will  probably  creep  into  the  register. 
This  drawbaok  however  will  be  largely  obviated 
bv  the  system  of  check  information  explained 
above,  which,  coming  from  sources  unsolicited 
by  the  nurse,  is  more  likely  to  be  truthfully 
impartial. 

Thus  the  objects  of  the  Directoiy  will  be 
fulfilled.  Accurate  information  of  the  personal 
characteristics  and  professional  qualifications  of 
nurses,  will  always  be  at  hand.  Patients  will 
be  supplied  quickly,  with  trained  nurses. 
Physicians  will  have  the  satisfaction  of  knowing 
that    their   difficult   cases   will    be  nursed    by 


skilled  and  competent  hands,  and  precious  time 
saved, and  tiresome  and  vexatious  delays  avoided. 
And  as  the  best  nurses  will  always  have  the 
greatest  demand  it  will  serve  as  an  incentive  for 
the  others  to  attain  as  high  a  degree  of  excel- 
lence as  the  best,  and  for  these  to  attain  a 
higher. 

The  plan  is  well  worthy  of  the  patronage  of 
the  profession,  as  it  surely  will  obtain  that  of 
the  public.  It  behoves  the  Profession  generally 
to  give  it  their  hearty  countenance  and  support 
now  at  its  inception,  in  order  that  it  may  the 
more  quickly  attain  its  highest  sphere  of  use- 
fulness. Without  that  support  its  present  ad- 
vance will  be  checked  and  its  future  existence 
endangered. 


ANNUAL  DINNER  OF  THE  TORONTO 
SCHOOL  OF  MEDICINE. 

The  Students  of  the  Toronto  School  of  Me- 
dicine held  their  9th  Annual  Dinner  on  the 
evening  of  the  14th  ult.,  in  the  Pavilion  of  the 
Horticultural  Gardens.  The  concert  room  was 
prettily  decorated  with  flags,  and  the  galleries 
were  graced  with  a  pressing  throng  of  the  fair 
sex  and  their  escorts.  According  to  the  report 
of  the  daily  papers,  about  two  hundred  guests 
sat  down  to  dinner,  the  chair  being  occupied 
by  Mr.  H.  S.  Gierke,  of  the  Fourth  Year.  The 
first  vice-chair  was  filled  by  Mr.  S.  Stewart, 
B.  A.,  of  the  3rd  year ;  the  second  by  Mr.  H. 
Martin,  of  the  2nd  year ;  and  the  third  long- 
itudinal table  was  presided  over  by  Mr.  Robin- 
son, the  Secretary  of  the  Committee.  Amongst 
the  distinguished  guests  seated  at  the  cross- 
table  were,  Hon.  Edward  Blake,  Chancellor  of 
the  University  of  Toronto ;  Mr.  Wm.  Mulock, 
M.P.,  Vice-Chancellot,  Mr,  James  Beaty,  M.P., 
Principal  Caven,  Professor  Mc Vicar,  Principal 
Buchan,  Mr.  Pernet,  Revs.  Dr.  King,  S.  J. 
Hunter,  Dr.  Dewart,  J.  Peai'son,  Mr.  Arch. 
McMurchy,  M.A.,  Hon.  W.  C.  Howells,  U.  S. 
Consul,  Mr.  Alfred  Baker,  M.A.,  Dr.  O'Reilly, 
Dr.  Fulton,  Dr.  Clark,  of  the  Asylum,  Mr. 
Henry  Pellatt,  and  Mr.  Davidson,  of  Trinity 
Medical  School.  The  Faculty  of  the  School 
turned  out  in  full  force.  In  accordance  with 
the  usual  custom  tea,  coffee,  and  water  were 
the  only  beverages.     The  Chairman,  in  an  able 


OF  MEDICAL  SCIENCE. 


401 


speech,  welcomed  the  guests,  thanked  his  fel- 
lows for  the  proof  of  their  confidence  in  elect- 
ing him  to  that  position  of  honour,  explained 
the  innovation  of  having  ladies  in  the  gallery, 
and  hoped  next  year  to  have  them  participate 
more  closely  in  the  annual  festivities,  by  the 
institution  of  a  conversazione.  The  usual  loyal 
and  patriotic  toasts  were  drunk  ;  Mr.  Mulock, 
responding  for  the  Dominion  Parliament.  In 
proposing  the  "  Universities,  Colleges,  and 
Sister  Institutions,"  the  Vice-chairman,  Mr. 
Stewart,  spoke  strongly  in  favour  of  the  unifi- 
cation of  the  Degree  conferring  powers  in  gen- 
eral, and  warmly  advocated  the  amalgamation 
of  the  teaching  forces  of  the  two  medical 
schools  in  this  city.  The  toast  was  eloquently 
responded  to  by  Mr.  Blake,  Dr.  Dewart,  Prof 
McYicar,  Principal  Caven,  Dr.  Fulton,  and 
Mr.  Davidson.  It  must  have  been  a  source  of 
much  gratification  to  the  Chancellor  and  Vice- 
Chancellor  of  the  University  to  observe  the 
terms  of  respect  and  aflfectionate  regard  in 
which  "  that  godless  institution  "  was,  on  all 
hands  referred  to.  "  The  Sister  Professions," 
brought  the  Rev.  Mr.  Pearson,  Principal 
Buchan,  and  Mr.  James  Beaty,  M.P.,  to  their 
feet.  "Our  Faculty  "  was  responded  to  by  Dr. 
Aikins,  who,  in  the  course  of  his  speech,  threw 
out  the  excellent  suggestion  that  the  examiners 
of  the  Medical  Council  should  be  paid  by 
government,  and  that  the  students  should  not 
be  taxed  to  support  an  examination  instituted 
solely  in  the  public  interest.  Dr.  Richardson 
being  loudly  called  for  also  replied,  and  urged 
the  institution,  in  University  College,  of  a  Chair 
of  Anatomy  and  Physiology.  This  would  not 
contravene  the  statute,  these  subjects  being 
purely  scientific, — an  integral  part  of  the 
science  course,  and  also  of  a  liberal  education. 
"Graduates  and  Graduating  Class,"  was  re- 
sponded to  by  Dr.  McLaughlin,  M  P.P.,  and 
Mr.  J.  G.  Wild  ;  "  Toronto  General  Hospital," 
by  Dr.  O'Reilly;  "The  Freshmen,"  by  Mr. 
Greig,  B.A.  ;  and  the  "Ladies,"  by  Mr.  Ellis. 
During  the  evening  the  Students'  Glee  Club 
enlivened  the  proceedings  with  songs  and 
choruses.  On  the  part  of  the  students  the 
speeches  were  excellent ;  indeed,  we  do  not 
remember  ever  to  have  met  such  uniform  ex- 
cellence in  after  dinner  speaking  in  a  gathering 


of  young  men  as  was  here  manifested.  Whether 
in  consequence  of  the  presence  of  the  ladies  or 
a  combination  of  circumstances,  we  cannot 
pretend  to  say,  but  all  present  declared  this 
Ninth  Annual  Dinner  to  be  the  most  successful 
gathering  of  the  kind  yet  witnessed. 


A  SUMMER  SESSION. 

We  were  pleased  to  hear  Dr.  Fulton  an 
nounce,  in  his  speech  at  the  Trinity  School 
Dinner,  that  he  intended  shortly  to  advocate,  in 
the  Canada  Lancet,  the  establishment  of  a  sum- 
mer course  of  lectures  for  the  better  treatment 
of  certain  subjects,  and  the  relief  of  the  over- 
crowded and  too  brief  winter  session.  Dr. 
Grasett's  advocacy  of  such  a  course  in  his 
introductory  lecture  at  Trinity,  this  year, 
further  shows  that  that  faculty  is  being  awak- 
ened to  the  necessity  for  such  an  institution  j 
and  from  convei'sations  which  we  have  had  at 
various  times  with  members  of  the  Toronto 
School  we  are  convinced  that  they  have  long 
recognised  the  importance  and  desirability  of 
thus  utilizing  the  spring  and  summer  months. 
We  are  gratified  to  find,  therefore,  that  a 
course  which  we  have  long  advocated,  at  length 
gives  promise  of  blossoming  into  fruit. 

In  the  issue  of  this  Journal  for  the  month 
of  June,  1878,  will  be  found  a  leading  article 
on  the  subject  of  Medical  Education,  to  which 
we  can,  with  satisfaction,  refer  those  interested 
for  what  we  believe  to  be  sound  doctrine  upon 
more  points  than  one.  The  language  we  then 
held  on  the  present  subject  we  repeat  now 
without  apology  for  the  iteration,  since  the 
want  is  there  plainly  stated,  and  the  means  of 
securing  it  briefly  suggeste  1.  "  It  is  high 
time  that  a  short  summer  course  should  be 
adopted.  It  cannot  be  worked  successfully 
unless  made  compulsory  by  the  Council ;  and 
there  is  no  reason  why  Botany,  Microscopy, 
part  of  Materia  Medica,  Practical  Chemistry, 
and  Toxicology,  and  even  Medical  Jurispru- 
dence and  Sanitary  Science,  should  not,  some  few 
or  all  of  them,  be  taught  in  a  summer  session, 
and  thus  lighten  the  amount  of  lecturing  in 
the  winter.  With  the  plenary  powers  with 
which  our  Council  has  been  endowed,  with  so 
many  teachers  among  its  members,  it  is  aston- 


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ishin^  that  some  of  these  reforms  have  not 
been  more  strongly  advocated  during  the  past 
eight  (now  twelve)  yeare."  Students  being 
detained  in  the  city  so  many  more  months  in  the 
year,  the  opportunities  for  the  most  useful  part 
of  their  instruction,  viz.,  bedside  experience  in 
the  wards  and  out-patient  department  would 
be  greatly  inci-eased.  We  do  not  know 
whether  the  proposition  made  by  Dr.  Fulton, 
at  the  dinner  of  the  Toronto  School  of  Medicine 
the  other  night,  to  iuitiate  the  much-talked  of 
amalgamation  of  the  schools  by  a  conjunction 
of  their  junior  members  for  the  formation  of  a 
summer  course  be  feasible  or  not.  But  we  do 
know  that  a  conjunction  of  the  representatives 
of  the  schools  in  pressing  the  matter  upon  the 
attention  of  the  Medical  Council,  could  not 
fail  to  result  in  the  inscription  of  a  much- 
needed  and  beneficent  enactment  on  the  statute- 
book  of  that  body. 


ANNUAL  DINNER  OF  TRINITY  MED- 
ICAL SCHOOL. 
The  Sixth  A.nnual  Banquet  of  the  students  of 
Trinity  Medical  School  was  held  in  the  Rossin 
House,  on  the  evening  of  the  8th  of  November, 
when  a  large  gathering  of  students,  their 
friends  and  well-wishers,  sat  down  to  an  excel- 
lent repast  presented  in  Mr.  Irish's  best  style. 
The  chair  and  vice  chairs  were  occupied  respec- 
tively by  Messrs.  W.  F.  Dickson,  Spragge,  and 
Lynch,  while  Mr.  E.  M.  Hoople  tilled  the 
arduous  post  of  honorary  secretary  to  the  com- 
mittee. Among  the  guests  occupying  places  of 
distinction  we  observed  the  Hon.  G.  W.  Allan, 
(Chancellor  of  Trinity)  ;  Prof.  Goldwin  Smith  ; 
Mr,  Wm.  Mulock,  M.P.  (Vice-Chancellor  of 
Toronto)  ;  Mr.  Jam3s  Beaty,  M.P.  ;  Rev.  Dr. 
Castle,  (McMaster  Hall) ;  Principal  Caven, 
(Knox  College)  ;  Principal  Buchan.  (U.C.  Coll.) 
Dr.  Daniel  Clark,  (Asylum)  ;  Mayor  McMur- 
rich  ;  Dr.  O'Reilly,  (Hospital)  ;  Rev.  John 
Langtry ;  Dr.  Canniff;  Dr.  Mullin,  (Hamilton); 
Dr.  Burritt,  (Med.  Council)  ;  Dr.  Allison, 
Med.  Council) ;  the  Faculty  of  the  School,  and 
numerous  graduates.  After  doing  ample  jus- 
tice to  the  excellent  viands,  the  list  of  toasts 
was  attacked  with  vigour,  on  temperance  prin- 
ciples. In  responding  for  the  Army  and  Navy, 
Capt.  Drayton  directed  attention  to  the  numer- 


ous points  of  novelty  in   military  and    naval 
warfare  illustrated  by  the  late  Egyptian  cam- 
paign, and  pronounced  the   result  as  an  ample 
vindication  of  the  short  term  of  service  system, 
Mr,  Beaty  and  Mr,   Mulock   replied   for   the 
Dominion    Legislature,     the    one  facetiously, 
the  other  jocosely.     The  Mayor  was  happy  in 
answering  to  (or  for)  the  City's  Health,     He 
prophesied  that  we  should  soon  have  a  Medical 
Officer  of  Health,  though    if  all    his   schemes 
were  carried  out  perhaps  we   would  not  need 
one.     The   Press    was  accorded    an    unusually 
honourable  position,  being  the  next  toast  on  the 
list.       It  was   responded    to    by    Dr.    Fulton, 
[Lancet)  ;  Mr.  Pirrie,  {Telegram);  Mr.  McLean, 
(World);  Mr,  Ritchie,  {Rouge  et  Noir)  ;  and  Dr. 
Cameron,  (Can.  Jour.  Med.  Sc.)     Dr.   Fulton 
advocated    the    establishment    of    a    summer 
course.      The   toast    of  the    Universities  and 
Sister   Institutions  was   warmly  received  and 
ably  responded  to  by  Chancellor  Allan  (Trinity) 
Yice-Chapcellor  Mulock,  (Toronto) ;  Principal 
Buchan,  (U.  C.  Coll.) ;    Dr,  Castle,  (McMaster 
Halj)  ;  Principal  Caven,  (Knox  College) ;  and 
Mr,    Burke,  representing  the  students   of  the 
Toronto    School   of    Medicine.       Mr.    Burke's 
eloquence  was  especially  worthy  of  admiration 
and  mention.     He  warmly   advocated  the  fos- 
tering of  a  unity  of  spirit  and  the  strengthen- 
ing  of  the   bonds   of  friendship   between  the 
students  of  the  different  Schools,  and  evidently 
adopted   "  Peace,    Progress,    Knowledge,    and 
Brotherhood"    for   his    text.       Prof.   Goldwin 
Smith  and  others  replied  for  the   Learned  Pro. 
fessions.  Dr.  Burritt  for  the   Medical  Council, 
Dr.  Geikie  for  the  Faculty,  and  Dr.  Tesky  for 
The  Ladies.     In  the  course  of  his  remarks  Dr. 
Geikie  referred  to   the   surprising  success  and 
progress  of  the  School,  and  quoted  figures  to 
show  that  in  point  of  attendance  its  course  ah 
initio  had  been  one  of  uninterrupted  and  gratify- 
ing advance.     A  number  of  well-rendered  glees 
by  the  Students' Club  were  interspered  through- 
out the  proceedings  ;  and  their  song  descriptive 
of  the  characteristics  of  members  of  the  Faculty 
occasioned  much  merriment,  especially  among 
its  subjects.     On  the  whole  a   most  enjoyable 
evening  was  spent ;  and  all  connected  with  the 
arrangements  are  to  be  warmly  congratulated 
on  the  complete  success  attained. 


OF  MEDICAL  SCIENCE. 


403 


TUBERCULOSIS— FORMAD   vs.  KOCH. 

Some  few  weeks  ago  the  Chicago  Medical 
Journal  and  Examiner  announced  that 
Schmidt,  of  New  Orleans,  had  a  rod  in  pickle 
for  Koch's  Bacillus  Tuberculosis,  and  that  he 
shortly  intended  to  demonstrate  that  the  so- 
called  bacillus  was  nothing  more  than  a  fat 
crystal.  More  probable,  however,  and  more 
important,  as  not  being  solely  negative,  are  the 
investigations  announced  more  recently  (18th 
November)  by  Form  ad,  in  the  Philadelphia 
Medical  Times.  In  this  communication  the 
author  states  it  broadly  as  a  fact  that  there  is 
a  special  anatomical  peculiarity  in  every  tuber- 
cular or  scrofulous  subject — man  or  animals — 
whether  the  diathesis  be  inherited  or  acqxiired. 
His  statement  is  based  upon  and  verified  by 
hundreds  of  dissections  (1000  of  animals  alone) 
of  men  and  animals,  normal  and  pathological ; 
and  the  anatomical  peculiarity  observed  is  this  : 
the  organs  supposed  to  be  concerned  in  the 
production  of  white  blood  corpuscles  are  dis 
proportionately  large  relatively  to  the  size  of 
the  animal,  and  there  exists  a  narrowness 
of  the  lymph  spaces  (connective  tissue)  and 
their  partial  obliteration  by  cellular  ele- 
ments. Only  beings  possessing  such  anomal- 
ous structure  of  the  connective  tissue  have 
primary  tuberculosis ;  and  such  invariably  be- 
come tubercular  from  any  injury  resulting  in 
inflammation  (damage).  This  condition  may 
be  acquired  by  malnutrition  and  confinement. 
Inflammation  (damage)  is  a  necessary  starting 
point  of  tuberculosis  even  in  those  predisposed. 
No  inflammation,  no  tuberculosis.  Non-scro- 
fulous animals  may  acquire  tubercular  disease 
through  injuries  of  serous  membranes,  perito- 
neum, pleura,  &c.  The  presence  of  the  bacilli 
is  secondary,  and  the  tubercular  tissue  is  a 
suitable  nidus  for  their  growth.  As  soon  as 
the  tuberclar  tissue  undergoes  complete  change, 
degeneration  and  softening,  the  bacilli,  as  Koch 
admits,  disappear.  Koch's  view  of  giant  cells 
being  mere  special  capsules  of  the  bacilli  is  an 
unwarrantable  mistake.  His  claim  that  the 
Bacillus  Tuberculosis  difiers  from  other  bacilli 
morphologically  and  in  its  behaviour  to  stain- 
ing fluids,  Formad  and  Bodamer  have  failed  to 
confirm.  Wood  and  Formad,  in  their  numerous 
experiments,  have  observed  that  bacteria  may 


acquire  special  morphological  and  physiological 
features  in  culture.  In  making  his  experiments, 
Koch  injected  his  culture  fluids  into  any  part 
indiscriminately  in  scrofulous  animals  (rabbits 
and  guinea  pigs),  but  in  non-scrofulous  animals 
(dogs,  rats,  and  cats),  he  injected  them  only  into 
the  peritoneum  or  anterior  chamber  of  the  eye, 
where  we  know,  from  old  experience,  that  any 
irritation  may  create  tuberculosis.  The  pre- 
sence of  the  bacilli  may,  however,  play  an  im- 
portant role  in  phthisis,  and  even  condition 
the  fatal  issue  of  the  disease.  They  effect  com- 
plete destruction  of  diseased  tissue  which,  in 
their  absence,  might  possibly  recover.  They 
may  thus  prove  a  true  cavsa  mortis,  though  not 
the  veritable  causa  or  materies  morbi. 


THE  UNIFICATION  OF  THE  SCHOOLS. 

During  the  recent  discussion  in  the  lay  press 
and  elsewhere  of  the  subject  of  School  fusion, 
it  has  not  been  at  all  unusual  to  hear  it  said 
(by  Schoolmen)  that  the  sole  requisite  for 
securing  perfection  to  both  Schools  is  the  ex- 
istence of  an  exclusive  hospital  for  each.  That 
our  material  wealth  on  the  one  hand,  or  extent 
of  population  on  the  other,  is  sufficient  to  pro- 
vide either  the  material  or  the  men  for  two 
fully  equipped  Schools  of  Medicine,  is  an 
hypothesis  which  the  irony  of  experience  and 
circumstances  daily  negatives.  And  drawing 
an  argument  for  analogy  or  those  "  odious  com- 
parisons," which,  though  distasteful,  are  some- 
times beneficial,  we  may,  perhaps,  ponder 
profitably  the  following  remarks.  Speaking  of 
the  competition  between  the  Metropolitan  and 
Provincial  Schools  of  Medicine,  the  Lendon 
Lancet  says  : — "  One  of  the  advantages  of  this 
competition  of  the  Provinces  may  be  to  induce 
some  concentration  and  combination  of  Metro- 
politan Schools.  Birmingham  has  set  a  good 
example  in  this  respect.  Its  Medical  School 
began  in  1828  as  the  Birmingham  Royal 
School  of  Medicine  and  Surgery.  Local  medi- 
cal energy  led  to  the  formation  of  a  second 
School  in  1851 — Sydenham  College.  The  two 
institutions  in  1858  were  wisely  merged  into 
one — Queen's  College ;  and  in  1873,  for  the 
purposes  of  clinical  teaching,  the  practices  of 
the  General  and  Queen's  Hospital  were  amal- 


404 


CANADIAN  JOURNAL 


gamated,  and  students  w»»re  required  to  attend 
each  hospital  alternately  for  six  months.  A 
similar  conBolidation  has  taken  place  in  New- 
castle-ujK)n-Tyne,  very  much  to  the  strength- 
ening of  the  School."  If  such  remarks  are 
applicable  to  the  great  Schools  of  the  mother- 
land, how  much  more  pertinent  are  they  to  the 
conditions  which  obtain  with  us  1  The  Lancet 
goes  on  to  say  :  "  The  time  may  come  when  a 
reduction  in  the  number  of  the  licensing  bodies 
will  set  the  Medical  Council  at  liberty  to  ascer- 
tain tlie  efficiency  of  the  Medical  Schools  and 
the  supply  of  the  means  of  teaching  and  of 
capable  teachers  ;  meantime  the  competition  of 
Schools  is  the  only  fact  to  rely  on  for  ensuring 
better  medical  education."  With  us,  on  the 
other  hand,  where  we  have  but  one  licensing 
body,  the  time  has  already  come  when  a  Gen- 
eral Medical  Council  of  Education  and  Regis- 
tratio'i  might  reasonably  be  expected  to  fulfil 
this  obvious  function  of  its  existence,  and 
where  consequently  the  rivalry  of  Schools  is 
no  longer  necessary  to  secure  a  high  degree  of 
proficiency  in  tf-ducating  (mark  the  derivation) 
the  mens  medica. 


THE    REPRESENTATION    OF    THE 
SCHOOLS  AND  OF  THE  PRO- 
FESSION ON  THE  HOSPI- 
TAL STAFF. 

The  Mail  reporter  in  his  interview  with  Dr. 
Aikins  anent  amalgamation  of  the  Schools 
reports  him  to  have  said  "that  the  medical 
attendants  at  the  Hospital  should  be  supplied 
entirely  by  the  teaching  staff  of  the  Schools," 
and  that  the  present  system  was  "  fair  enough 
as  far  as  the  profession  were  concerned,  but  by 
no  means  so  beneficial  for  the  Schools."  Allow- 
ing the  last  part  of  the  quotation  to  pass 
without  demurrer,  let  us  see  what  would  be  a 
fair  representation  of  each  ;  and  since  we  know 
the  Doctor  to  be  a  consistent  advocate  of  rep- 
resentation by  j)opulation,  and  the  Schools  are 
but  private  Institutions  existing  for  their  indi- 
dividual  benefit,  let  us  assume  the  numerical 
strength  as  a  basis  of  comparison.  The  Schools 
together  number  some  31  members  of  the 
profession,  and  they  have  ten  of  their  number 
on  the  staflF;  the  profession   of  the  city — non- 


Schoolmen — number  some  120,  and  their 
representatives  are  four.  Truly  an  equable 
allotment  to  an  impartial  vision  !  In  England 
the  School  and  the  Hospital  are  one.  The 
Hospital  supports  the  School,  or  the  School 
supports  the  Hospital,  as  the  case  may  be  ;  and 
if  a  man  by  influence  or  worth  succeeds  in 
being  appointed  to  a  Hospital,  they  can  gener- 
ally make  a  place  for  him  in  the  School.  But 
they  are  not  supported  out  of  public  funds. 
Only  three  of  the  Metropolitan  Hospitals  are 
endowed ;  the  rest  lead  a  from  hand-to-mouth 
existence,  and  scrape  along,  generally  with 
some  ot  their  wards  closed,  until  some  rich 
man  dies  and  leaves  them  the  wherewithal  to 
open  them  again.  Only  five  of  the  Metro poli 
tan  Hospitals  are  larger  than  our  own ;  and 
some  of  them  have  no  Schools  connected  with 
them  ;  and  yet,  in  many  instances,  the  person- 
nel of  their  staff  is  by  no  means  to  be  despised. 
Good  Schoolmen  will  probably  make  a  good 
hospital  staff;  but  it  does  not  follow  that  non- 
Schoolmen  will  not.  The  educational  benefits 
of  a  hospital  are  not  confined  to  teachers  and  pu- 
pils ;  there  is  a  large  though  humbler  class  of 
workers  in  the  profession  who  are  quite  capable 
and  very  desirous  of  learning  from  hospital 
experience ;  and  if  it  be  true  that  connection 
with  a  hospital  confers  a  certain  degree  of 
prestige,  and  opens  the  way  to  consultations, 
why  should  not  the  hard-working  private  man 
aspire  thereto  ? 

In  Edinburgh  certain  duly  accredited  gentle- 
men are,  on  application,  allowed  to  deliver 
lectures  to  classes  on  certain  subjects,  as  extra- 
mural lecturers,  and  certificates  of  attendance 
on  such  classes  are  recognized  for  University 
and  other  purposes.  Why  should  we  not  have 
something  similar  instituted  here,  and  thus  cut 
the  Gordian  knot  of  this  perplexity  by  all 
becoming  quasi  Schoolmen  ? 


Malaria  in  Skin  Diseases — (A  correction). 
Dr.  Lunsford,  P  Yandell,  of  Louisville,  desires 
us  to  correct  the  statement  which  has  been 
widely  circulated  in  the  medical  press,  that 
"he  attributes  all  skin  eruptions  to  malaria.'' 
His  views  are  that  "  malaria  is  the  chief  (not 
sole)  source  of  acute  skin  disease ;  and  scrofula 
is  the  chief  source  of  chronic  skin  disease." 


OF  MEDICAL  SCIENCE. 


405 


THE    ONTARIO    MEDICAL    REGISTER 
AND  REGISTRABLE  QUALI- 
FICATIONS. 

Dr.  Pyne,  the  able  and  indefatigable  Regis- 
trar   of    the  Medical    Council,    has   been    at 
infinite  pains  to  secure  the  utmost  certitude 
and  exactness  in  the  newly-issued  edition  of 
the  Register.     Since  the  book  is  in  the  hands 
of  the  great  majority  of  our  readers,   we  need 
not  refer  to  its  contents  further  than  to  allude 
to  the  gross  impropriety  on   the   part   of  the 
Council  of  allowing  the   registration   of  such 
titles  or   qualifications  (save   the   maik !)    as 
"  Proprietor  of  the  Pulmonary  Institute,  Tor. 
onto,"   "Proprietor  of  the  Throat   and  Lung 
Institute,  Detroit,"  **  M.A.,  of  the  American 
University  of  Philadelphia,"  which  never  had 
any  existence,  &c.     The  54th  paragraph  of  the 
late  Report  of  the  Royal  Commissioners  on  the 
Medical  Acts,  says  : — "  We  do  not  propose  to 
interfere  with  the  present  powers  of  Universi- 
ties as  corporations  to  confer  their  titles,   with 
or  without  examination.     We  think,  however, 
that  in  the  case  of  persons  entitled  to  be  regis- 
tered,   a    discretion   should   be   given  to   the 
Medical  Council  to  permit  these  titles  to  be 
registered  or  not,    as  they  think   fit."      And 
again,  in   paragraph  81  :  "  We  think  that  a 
column  should  be  set  apart  in  the  Register  for 
the  registration  of  higher  titles  recognized  by 
the  Medical  Council  as  indicating  substantially 
higher  medical  qualijications  than  are  required 
for  a  license."     Under  such  an  interpretation 
of  the  duties  of  the  Council  in  the  matter,  it 
might  of  course,  become  a  question  if  "  Fellow 
of  Trinity  Medical  School,"  or  "  Fellow  of  the 
Royal    College    of    Surgeons  of  Edinburgh," 
would  be  registrable  titles,  as  being  more  or 
less  honorary,  and  not   indicating  a  substan- 
tially higher  medical  qualification    than    the 
degree  or  license.     But  to  the  registration  of 
honorary  degrees  from  reputable  Institutions 
we  have  not  so  much  objection.     It  is  against 
the   registration    of   additions   such    as    first 
named   above   that   we   revolt ;  and   it   pains 
us  to  find  the  degree  of  our  Provincial  Univer- 
sity entered  in  the  same   column   therewith. 
If  the  Council  have  not  now  the  authority  to 
refuse   admission  to   such  blemishes,  the  im- 
mediate procurement  of  that  power  is  impera- 
tively demanded.     In  case  of  failure,   let  the 
day  of  free-trade  in  medicine  dawn  again  in 
this  benighted  Province. 


THE  BIRMINGHAM  MEDICAL  RE- 
VIEW, AND  THE  ONTARIO  COLLEGE 
OF  PHYSICIANS  AND  SURGEONS. 

The  Review  in  its  November  issue  says,  "We 
have  heard  a  good  deal  about  the  course  taken 
by  the  New  York  Medical  Society  in  sanction- 
ing consultations   by  its   members  with   duly 
qualified  homoeopaths,  but   it   seems   that   in 
Canada   they  go  a  good  deal  further,  for  the 
College  of  Physicians  and  Surgeons  of  Toronto, 
(sic.)  has  a  homoeopathic  member  of  the  Exam- 
ining Board.     *     *     *     This  is  rather  weak- 
kneed  of  the  Toronto  {sic)  college  ;  it  might  at 
least  confine  its   examinations  to  well  ascer- 
tained scientific  facts,  and  leave  all  speculative 
questions  alone."     This  citation  only  serves  to 
show  the  ignorance  of  the  writer  of  the  topic 
on  which  he  wrote.     It   can   scarcely,    there- 
fore, have  come  from  Dr.  Saundby's  pen.     For 
the  information  of  the  writer  we  may  mention 
that  the  College  of  Physicians  and  Surgeons  of 
Ontario,    to   which   alone   his   remarks   could 
apply,  is  an  institution  erected  by  statute  for 
the  examination  and  registration  of  all  practi- 
tioners of  medicine  in  the  province,  of  whatever 
school,  sect,  or  pathy  ;  that  it  is  the  sole  licens- 
ing power  in  the  province  ;  and  that  the  num- 
ber and  character  of  its  members  and  examiners 
is  also  fixed  by  statute.     We  fear  that  our  old 
world  contemporary  is  better  acquainted  with 
the  views  of  the  Canada  Lancet  on  the  Homoeo- 
pathic question  than  with  our  own.     But  if  he 
will  take  the  trouble  to  refer  to  our  comments, 
in  several  issues  of  this  year,  upon  the  action 
of  the  New  York  State  Society,  he  will  find 
that  the  profession  of  Ontario,  for  whom  toe 
profess  to  speak,  is  not  so  weak-kneed  on  this 
particular  question.     For  the  soundness  of  the 
Ontario,  or  any  other,  legislature  in  matters 
medical  we  are  not  prepared  to  answer. 


Sir  Thos.  Watson  has  had  symptoms  of 
thrombosis  of  the  smaller  cerebral  arteries  of 
the  right  side,  probably  near  the  parieto-occipital 
fissure.  Some  bladder  irritation  supervened, 
and  there  has  been  a  gradual  but  continuous 
loss  of  strength.  This  venerable  physician  is 
now  91  yeai-s  of  age. 


406 


CANADIAN  JOURNAL 


Canadian  and  American  Hotels. — The 
London  Lancet,  in  a  recent  annotation,  directs 
the  attention  of  the  travelling  public  to  "  the 
dangers  attending  a  lengthened  stay  in  an 
American  or  a  Canadian  hotel."  The  Lancet 
derives  its  information  from  a  correspondent, 
who  rei>ort8  himself  as  being  made  seriously  ill 
by  sleeping  one  night  "  in  a  bedroom  where 
thei-e  was  a  fixed  basin,  which  communicated 
directly  with  the  sewer  without  any  'ntervening 
trap."  He  alleges  that  an  examination  of  many 
of  these  arrangements  revealed  "  the  fact  that 
they  are  frequently  untrapped,  and  that  when 
traps  are  used  they  are  of  a  bad  pattern."  If  this 
is  so — and  its  truth  we  are  neither  prepared  to 
affirm  nor  deny — it  is,  of  course,  a  serious 
matter  to  the  travelling  public,  and  it  becomes 
them  to  take  what  precautions  they  can  to 
guard  against  the  ill  effects  of  the  escape  of 
mephitic  emanations  from  the  sewers.  To  the 
proprietors  of  hotels  we  would  suggest  the  pro- 
priety of  procuring  and  posting  in  a  prominent 
place  a  certificate,  from  a  competent  and  recog- 
nized authority,  that  their  plumbing  arrange- 
ments have  been  inspected,  and  are  in  a  safe 
and  sound  condition.  This  they  owe  to  the 
comfort  of  their  guests ;  and  a  certitude  of 
safety  they  owe  to  themselves,  for  being  amen- 
able to  insalubrious  influences,  they,  in  the 
presence  of  such,  like  other  mortals,  "  must  die 
and  not  live."  Let  them,  therefore,  see  to  it 
that  they  "  put  their  house  in  order." 


First  Aid  in  Railway  Accidents. — A 
couple  of  cases  of  railway  smash  lately  admitted 
to  the  Hospital  suggest  anew  the  propriety 
and  advisability  of  our  Canadian  railways  fol- 
lowing the  example  set  them  in  the  Old  World, 
and  more  recently  in  the  New,  by  the  Pennsyl- 
vania Railroad  Company.  According  to  the 
Medical  Record  this  Company  has  purchased 
two  thousand  tin  boxes  containing  some  surgi- 
cal materials  likely  to  be  of  service  in  cases 
of  accident,  and  kept  in  the  locomotive  con- 
stantly in  a  fit  state  for  immediate  and  effective 
use.  Each  box  contains  1  rubber  compress, 
1  package  of  absorbent  cotton,  6  rolls  of  band- 
ages, and  1  pyramid  of  pins  ;  and  accompany- 
ing  these  a   few  simple    directions   for   their 


utilization  in  an  emergency.  The  immediate 
arrest  of  blood-loss,  and  the  prompt  application 
of  an  occlusive  dressing  in  cases  of  serious  ac- 
cident so  often  decide  the  issue  between  life 
and  death  that  we  deem  it  sufficient  merely  to 
make  mention  of  the  matter,  and  we  trust  we 
shall  ere  long  realize  the  truth  of  the  ancient 
utterance,  verbum  sapientibus  sat. 


Course  of  Orthopedic  Lectures. — We 
have  received  an  announcement  of  a  course  of 
lectures  on  Orthoptedic  Surgery,  to  be  de- 
livered by  Dr.  Newton  M.  Shaffer,  under  the 
auspices  of  the  Trustees  of  the  N.  Y.  Ortho- 
pasdic  Dispensary  and  Hospital,  at  their  In- 
stitution, No.  126  East  59th-street,  New  York. 
The  lectures  are  to  be  delivered  on  Thursday 
afternoons,  at  half-past  four  o'clock,  from 
November  16th,  1882,  to  February  15th,  1883, 
inclusive.  The  Course  is  free  to  the  medical 
profession  and  students.  We  would  advise  all 
Canadians  who  happen  to  be  in  New  York  this 
winter  by  no  means  to  miss  hearing  some  of 
these  lectures. 


Jonathan  Hutchinson's  advice  to  Medi- 
cal Students. — (Peroration  to  introductory  at 
London  Hospital). — "  If  now  I  were  to  sum  up 
in  one  sentence  what  I  have  been  enforcing  it 
would  be  this  :  The  secret  of  all  noble  life  lies 
in  belief,  and  the  characteristic  of  all  noble 
minds  is  the  vigour  with  which  they  believe 
that  which  is  true.  Try  to  attain  belief  in  the 
reality  of  all  things,  so  shall  you  never  want 
for  motives,  so  shall  you  be  able  to  live  and 
work  without  hurry  and  without  sloth.  Fin- 
ally permit  me  to  commend  to  you  this  formula  : 
prize  strength,  love  the  beautiful,  practise  self- 
denial,  and  be  patient," 


The  Archives  of  Dermatology,  the  Quarterly 
Journal  of  Skin  and  Venereal  Diseases,  so  ably 
conducted  for  the  last  eight  years  by  Dr.  L. 
Duncan  Bulkley,  the  distinguished  Dermatolo- 
gist of  New  York,  has  ceased  to  appear,  owing 
to  the  pressure  of  other  demands  on  the  editor's 
time.  We  shall  miss  our  old  friend  very 
much. 


OF  MEDICAL  SCIENCE. 


407 


Our  old  friend,  the  New  York  Medical 
Journal  and  Obstetrical  Review,  formerly  edited 
by  James  B.  Hunter,  but  now  by  Frank  P. 
Foster,  has  announced  its  intention  of  appearing 
weekly  after  the  beginning  of  the  coming  year. 
We  wish  it  every  success  in  its  new  venture. 


The  American  Journal  of  Obstetrics,  published 
by  Wm.  Wood  &  Co.,  and  edited  by  Paul  F. 
Munde,  (who  by  the  way  has  just  succeeded 
Noeggerath  as  Gynaecologist  to  the  Mt.  Sinai 
Hospital),  will  henceforth  appear  monthly. 


It  is  announced  that  the  Medical  School  in 
connection  with  the  Johns  Hopkins'  Hospital, 
of  Baltimore,  will  be  opened  in  the  Fall  of  '83. 


PERSONAL. 

Dr.  Ames  has  removed  from  Mart  in  town  to 
Ai'kona. 

Dr.  Harrison,  of  Toronto,  has  removed  to 
Cam  bray. 

Dr.  W.  H.  Aikins,  of  this  city,  now  in 
Vienna,  has  just  recovered  from  diphtheria. 

Prof.  Virchow  has  been  seriously  ill.  The 
latest  accounts,  however,  are  reassuring. 

Dr.  Casgrain  has  been  appointed  one  of  the 
internes  at  the  Hospital. 

Dr.  W.  J.  Wilson  has  returned  fx'om  Pitts- 
field,  Mass.,  and  is  now  practising  at  Rich- 
mond Hill. 

Dr.  Nasmith,  Toronto  School  of  Medicine, 
has  been  admitted  L.  R.  C.  P.  Edin.,  and 
L.  F.  P.  S.  Glasgow. 

The  late  Mr.  F.  M.  Balfour,  Prof,  of  Mor- 
phology, at  Cambridge,  bequeathed  £1000  to 
Michael  Foster,  to  foster  the  study  of  Physi- 
ology. 

J.  F.  W.  Howitt,  (of  the  Toronto  School) 
passed  the  primary  examination  of  the  Royal 
Coll.  of  Surgeons,  in  the  beginning  of  November. 

Dr.  I.  T.  Small,  of  this  city,  was  unlucky 
enough  to  fall  a  couple  of  weeks  ago,  and  sus- 
tain a  fracture  of  the  left  humerus  about  its 
middle. 

We  regret  very  much  to  learn  that  Dr. 
Robert  Howard,  of  Montreal,  has  had  the  great 
misfortune  to  lose  his  son,  aged  4^  years,  from 
diphtheria. 


We  are  glad  to  hear  that  Dr.  J.  R.  Jones, 
of  Winnipeg,  who  was  thrown  fi  om  his  carriage 
by  a  runaway  horse,  has  recovered  completely 
from  the  shock. 


OBITUARIES. 

Davaine,  the  discoverer  of  the  Bacillus  An- 
thracis,  has  paid  the  debt  of  nature,  aged  71. 

Another  distinguished  chemist,  and  the  in- 
ventor of  an  electric  battery,  George  Leclanch6, 
is  also  dead,  aged  43. 

Dr.  Henwood,  one  of  Hamilton's  oldest 
and  most  respected  physicians,  succumbed  last 
month  to  pulmonary  abscess  together  with  some 
cardiac  affection.  He  was  resident  physician 
in  our  Toronto  Hospital  from  1842  to  1848, 
and  in  the  Hamilton  Hospital  from  1848  to 
1868,  since  which  time  he  was  engaged  in 
private  practice. 

Bhola  Nath  Bose,  M.D.,  M.R.C.S.,  the  first 
East  Indian  to  hold  the  degree  of  the  University 
of  London,  which  he  took  in  1847,  died  from 
carbuncle,  on  the  Ist  of  October  last.  The  whole 
of  his  professional  life  was  spent  in  India,  with 
the  exception  of  a  two-year  furlough  in  England 
during  which  he  wrote  his  two  works,  "A  new 
System  of  Medicine;  Entitled  Recognisant  Med- 
icine, or  the  State  of  the  Sick,"  and  "  Principles 
of  Rational  Therapeutics." 

Henry  Draper,  M.D.,  Prof.  Chemistry,  Univ. 
City  of  New  York,  died  rather  suddenly  from 
pleurisy,  on  20th  November,  aged  46.  He  pub- 
lished a  Text  Book  on  Chemistry,  and  was  a 
frequent  contributor  to  astronomical,  electrical, 
and  photographic  literature.  He  was  the  dis- 
coverer of  oxygen  in  the  sun.  The  inscription 
on  the  medal  struck  for  him  by  order  of 
Congress,  in  consideration  of  his  observation  of 
the  Transit  of  Venus  in  1874,  is  his  appropri- 
ate epitaph : — "  He  adds  lustre  to  ancestral 
glory." 

Geo.  Critchett,F.RC.S.,  the  eminent  surgeon 
and  oculist,  who  for  eight  weeks  previously  had 
manifested  sj^^mptoms  of  cystitis,  enlarged  pro- 
state, and  granular  kidney,  died  rather  sud- 
denly on  the  Ist  of  November.  He  was  born 
in  1817  j  being  thus  65  years  of  age.  He  was 
successively  Demonstrator  of  Anatomy,  Assis- 
tant-surgeon, and  Surgeon  to  the  London  Hos- 


108 


CANADIAN  JOURNAL 


pital  ;  but  resigned  there  in  1863.  In  1876, 
he  succeeded  Mr.  Hulke  as  Ophthalmic  Surgeon 
at  the  Middlesex,  and  he  was  connected  with 
Moorfields  nearly  all  his  professional  life.  His 
operative  skill  was,  perhaps,  unsurpassed  ;  and 
the  plan  of  dividing  the  recti  muscles  subcon- 
junctivally  by  hook  and  scissors,  and  the 
method  of  enucleation  now  usually  practised, 
were  peculiarly  his  own. 

We  regret  to  have  to  record  the  death  of 
Dr.  John  R.  Dickson,  of  Kingston,  fi-om 
paralysis.  Dr.  Dickson  had  been  a  resident  in 
this  country  since  1837.  In  1842  he  took  the 
M.D.  of  the  University  of  New  York  and  the 
Provincial  License,  and  began  practice  in  King- 
ston. He  took  an  active  part  in  the  forma- 
tion and  success  of  the  Royal  College  of  Phy- 
sicians and  Surgeons  of  Kingston,  in  which 
he  occupied  the  chair  of  surgery.  H ;  was  a 
Licentiate  of  the  Royal  College  of  Physicians 
of  London,  and  a  Fellow  of  the  Royal  College 
of  Surgeons,  of  Edinburgh  ;  and  had  held  the 
posts  of  surgeon  to  the  Provincial  Penitentiary 
and  Medical  Superintendent  of  the  Asylum 
for  the  Insane  in  Kingston.  He  was  the  first 
president  of  the  Medical  Council  of  Ontario. 
For  the  last  four  years  he  was  not  engaged  in 
active  practice. 

One  of  the  old  pmctitioners  of  Montreal, 
Dr.  Aaron  Hart  David,  has  passed  away  in 
the  Tlst  year  of  his  age.  He  was  born  in 
that  city  in  1812,  studied  at  ^McGill  and  the 
University  of  Edinburgh,  where  he  graduated 
in  1835.  In  1852  he  edited,  in  conjunction 
with  the  late  Dr.  R.  L.  Macdonnell,  the 
Canada  Medical  Journal  which,  however,  did 
not  survive  the  dangers  of  infancy.  He  was 
also  instrumental  in  establishing  the  St. 
Liwrence  School  of  Medicine  which  met  a 
similar  fate.  In  1870  he  participated  in  the 
formation  of  the  medical  faculty  of  Bishop's 
College  in  which  he  was  Professor  of  Medicine 
and  Dean.  He  was  a  member  of  a  number  of 
scientific  societies,  home,  British,  and  foreign, 
and  acted  as  General  Secretary  of  the  Canada 
Mt^ical  Association  from  its  inception  up  to 
within  a  year  of  his  death,  which  was  occa- 
sioned by  that  most  painful  affection  cancer  of 
the  rectum. — Requiescat  in  pace. 


^aofe  gatl«$. 


Annual  Beport  of  the  Surgeon- General,  U.  S. 
Army,  1SS2. 


Brooklyn  Ilomceopathic  Hospital  Annual  Re- 
port for  1881. 


On  Causes  of  Consumption — An  Etiological 
Statistical  Report.  By  Edward  Playter,  M.D., 
Toronto. 


The  Physical  Basis  of  Moral  Insanity 
Viewed  in  relation  to  Alcoholic  Impressions. 
By  T.  L  Wright,  M.D.,  Bellefontaine,  Ohio. 
(Reprint  from  Alienist  and  Neurologist.) 


Tlve  Use  of  the  Ecraseur  for  Curing  Deep- 
seated  Fistula  in  Ano.  By  J.  M.  Gaston,  M.D., 
of  Campinas,  Brazil.  (From  Am.  Journal  of 
Med.  Sc) 

Proposed  Bill  to  Regulate  the  Practice  of 
Medicine  in  Michigan.  By  Henry  B.  Baker, 
M.D.,  Lansing,  Mich.  (Reprint  from  Mich. 
Med.  News.) 

Weekly  Bulletins  of  Health  in  Michigan; 
Weekly  Meteorological  Reports,  and  Monthly 
Reports  of  Deaths  in  Lansing,  Mich.  By  Henry 
B.  Baker,  M.D.,  Sec.  Bd.  Health. 


Fortieth  Report  to  Oie  Legislature  of  Massa- 
chusetts of  Births,  Marriages,  and  Deaths  in 
the  Commonwealth,  for  the  year  ending  Slst 
Dec, 1881. 

Weekly  Health  Bulletins,  with  Meteorological 
Reports,  issued  by  tJie  Provincial  Board  of 
Health  of  Ontario.  P.  H.  Bryce,  M.A.,  M.D., 
Secretary. 


An  Hitherto  Undescribed  Fracture  of  the  Astra- 
galus. By  Francis  J.  Shepherd,  M.D.,  CM., 
M.R.C.S.  Eng.,  Demonstrator  of  Anatomy, 
McGill  University.  (Reprint  from  Journal 
of  Anatomy  and  Physiology.) 


OF  MEDICAL  SCIENCE. 


409 


Rep<yrt  of  Secretary  (Thos.  F.  Wood,  M.D.), 
'and  an  Essay  on  Preventive  Medicine.  By  W. 
P.  Beall,  M.D.,  of  Greensborough,  Read  at 
Conjoint  Session  of  the  North  Carolina  Board 
of  Health  and  the  Medical  Society  of  North 
Carolina,  held  in  Concord,  May  10th,  1882. 


A  Handbook  of  Uterine  T/ierapeutics  and  of 
Diseases  of  Women.  By  Edward  John 
Tilt,  M.D.,  Past-president  of  the  Obstetrical 
Society  of  London,  etc.  New  York  :  Wm. 
Wood  &  Co.     Toronto  :  Willing  &  William- 


son. 


This  book  is  good  enough  in  its  way,  but 
among  the  many  excellent  works  that  have 
appeared  in  this  department  during  the  last  few 
years,  it  cannot  occupy  anything  higher  than  a 
second-rate  position. 


Questions  on  Human  Anatomy.  By  Samuel 
O.  L.  Potter,  M.A.,  M.D.,  with  sixty-three 
illustrations.  Philadelphia :  P.  Blakiston, 
Son  &  Co.,  1012  Walnut  street.  Toronto  : 
N.  Ure  &  Co. 

This  is  the  first  of  a  series  of  quiz-compends 
to  be  issued  by  the  publisher  at  $1.00  each, 
designed  to  assist  students  in  their  preparation 
for  the  quiz-class,  and  examinations.  Properly 
emjjloyed,  such  books  may  be  of  much  help  to 
those  for  whom  they  are  designed ;  but  the  temp- 
tation to  misuse  them  is  so  great,  that  their  very 
existence  is  fraught  with  danger  to  many. 
This  is  one  of  the  best  of  its  kind. 


Physicians'  Visiting  List  for  1883.  Philadel- 
phia :  P.  Blakiston,  Son  <fe  Co.  Toronto  : 
N.  Ure  &  Co. 

This  popular  YisitingXist  maintains  its  well- 
earned  reputation.  This  year,  as  usual,  such 
alterations  and  additions,  as  the  wants  of  the 
profession  seem  to  require  have  been  made. 
Among  the  new  and  useful  features  we  notice 
a  "  New  Table  of  Poisons  and  their  Antidotes," 
"  The  Metric  System  of  Weights  and  Measures," 
"  Posological  Tables,"  (giving  the  doses  both  in 
Apothecaries'  weights  and  measures,  and  those 
of  the  Metric  System).  We  have  seen  no  bet- 
ter Visiting  List  than  this,  which  can  be  had 
for  from  25  to  100  patients  weekly,  and  is  of  a 
suitable  size  and  shape  for  an  ordinary  pocket. 


The  Incidental  Effects  of  Drugs.  By  Dr.  L. 
Lewin,  Assistant  at  the  Pharmacological 
Institute  of  the  University  of  Berlin  :  Trans- 
lated by  VV.  T.  Alexander,  M.D.  New 
York :  William  Wood  &  Co.  Toronto  :  Wil- 
ling &  Williamson. 

This  is  an  excellent  and  useful  work  on  the 
important  subject  of  unusual  action  of  different 
medicines,  whether  depending  on  causes  peculiar 
to  the  individual,  the  circumstances  of  the 
case,  or  the  quality  of  the  drugs.  One  is  fre- 
quently puzzled  in  using  ordinary  medicines 
at  unexpected  results,  and  has  considerable 
difficulty  at  times  in  getting  satisfactory  ex- 
planations in  our  ordinary  text-books.  To 
such,  and  indeed  to  all  practitioners,  we  recom- 
mend the  work. 


Walsh's  Physicians'  Combined  Call  Book  and 
Tablet,  ^th  edition.  Published  by  Ralph 
Walsh,  M.D.,  332  C.  Street,  Washington, 
D.C. 

This  is  again  a  candidate,  along  with  the 
host  of  other  Visiting  Lists,  for  professional 
favor.  In  common  with  most  other  lists  the 
useful  part  is  preceeded  by  a  lot  of  miscellan- 
eous information  which  should  be  in  the  practi- 
tioner's head,  rather  than  in  his  pocket ;  but  we 
like  the  book  op  account  of  its  convenient  size, 
and  shape,  for  carriage  in  the  pocket,  and  be- 
cause it  is  in  a  way  perpetual,  the  names  of 
the  months,  and  dates  of  the  days,  being  blank. 
Each  page  is  ruled  for  34  names,  and  columns 
are  provided  for  the  No.  and  street.  It  is  well 
and  handsomely  issued  in  red  leather,  and 
closes  merely  with  a  stiff  flap. 


Lectures  on  Diseases  of  Children.  A  Hand-book 
for  Physicians  and  Students.  By  Dr. 
Edward  Henoch,  Director  of  the  Clinic 
and  Polyclinic  for  Diseases  of  Children,  in 
the  Royal  Charite,  and  Professor  in  the 
University  of  Berlin.  New  York  :  Wm. 
Wood  &  Co.  Toronto  :  Willing  &  William- 
son. 

The  author  of  this  book  is  evidently  a  care- 
ful observer,  and  has  had  a  wide  experience  in 
the  Charit6.  The  style  of  writing  is  clear  and 
concise,  though  not  specially  attractive.  Brief 
reports  of  cases  add  to  the  interest  in  the  dis- 
cription  of  diseases.  Diagnosis,  Prognosis,  and 
Pathology  are  all  that  could  be  desired.     Treat- 


410 


CANADIAN  JOURNAI. 


meut  is  sometimes  rather  meagre,  but  on  the 
whole  sound ;  and  opinions  ai^e  given  in  a 
decided  way  which  we  admire.  The  book  will 
not  supersede  such  as  Lewis  Smith's,  but  it 
will  be  found  instructive. 

On  Asthmn :  Its  Pathology  and  Treatment.  By 
Henry  Hyde  Salter,  M.A.,  F.R.S.  First 
American  from  the  last  Eng'ish  edition. 
New  York  :  \Vm.  Wood  k  Co.  Toronto : 
Willing  <fe  Williamson. 

Subscribers  to  Wood's  Library  receive  this 
work  as  the  September  No.  of  the  series.  Of 
the  intrinsic  merits  of  Salter  on  Asthma,  it 
would  be  idle  at  this  late  day  to  speak.  Hav- 
ing occupied  so  long  a  foremost  place  on  Eng- 
lish bookshelves  as  tlie  authority  on  the  subject, 
subscribers  to  the  library  cannot  but  be  pleased 
to  find  it  in  the  present  series.  Of  course, 
since  its  appearance  many  new  things  have 
been  written,  many  remedies  suggested,  and 
some  theories  promulgated,  but  we  doubt  if 
even  Berkhart,  our  latest  English  textbook,  is 
more  deserving  of  professional  acceptance  than 
the  old  authority  ot  Hyde  Salter. 


Materia  Medica  and  Therapeutics:  Inorganic 
Substances.  By  Charles  D.  F.  Phillips, 
M.p.,  M.R.C.P.,«fec.,  late  Lecturer  on  Ma- 
teria Medica  and  Therapeutics,  Westminster 
Hospital  Medical  School.  Edited  by  Lau- 
rence Johnson,  A.M.,  M  D.  New  York : 
Win.  Wood  &  Co.  Toronto:  Willing  k 
Williamson. 

This  is  the  sequel  to  Dr.  Phillips'  "  Materia 
Medica  and  Therapeutics — the  Vegetable  King- 
dom," edited  by  Dr.  Piffard,  and  published  in 
"  Wood's  Library,"  79.  The  author's  aim  is 
to  combine  Pharmacology  with  Therapeutics, 
as  he  considers  that  sufficient  attention  is  not 
paid  to  Pharmaceutical  Chemistry.  We  think 
he  has  succeeded  admirably,  and  the  work  is 
thoroughly  scientific,  while  sufficiently  practi- 
cal to  suit  the  requirements  of  either  the 
student  or  the  busy  practitioner.  His  Thera- 
peutics lacks  the  stamp  of  originality,  as  he 
culls  from  most  of  the  best  authorities,  but  he 
shows  good  judgment  in  his  selections,  and  in 
consequence  this  portion  will  prove  both  in- 
teresting and  instructive.  The  work  is  pub- 
lished in  two  volumes,  and  will  rank  well 
auiong  the  best  Dooks  we  have  on  this  subject. 


Speech  and  its  Defects  Considered  Physiologi- 
cally, Pathologically,  Historically,  and  Reme- 
dially.  By  Samuel  0.  L.  Potter,  M.A., 
M.D.,  (Lea  Prize  Thesis  of  Jefferson  Medi- 
cal College).  Philadelphia  :  P.  Blakiston, 
Son  &  Co.,  1012  Walnut  street,  1882.  Price 
$1.00,  pp.  116. 

A  big  title  for  a  small  book  ;  but  a  good 
book,  though  perhaj)8  not  a  good  title.  After 
a  pleasing  introduction,  the  subjects  of  phona- 
tion,  articulation,  and  speech,  are  briefly,  but 
clearly  stated,  after  which  follow  the  defects  of 
speech  under  the  titles  alalia,  paralalia,  and 
dyslalia,  or  stammering,  the  last  named  being 
the  piece  de  resistance  and  raison  d'  etre  of  the 
book.  It  is  very  fairly,  and  fully  discussei, 
and  the  various  theories  of  etiology  and  modes 
of  treatment  judiciously  presented.  An  ex- 
cellent bibliography  is  appended.  All  inter- 
ested and  uninterested  in  the  subject  may  read 
this  brochure  with  profit  not  unmixed  with 
pleasure. 


A  System  of  Human  Anatomy,  including  its 
Medical  and  Surgical  Relations.  By  Har- 
rison Allen,  M.D.,  Proft  ssor  of  Physiology 
in  the  University  of  Pennsylvania,  &c. 

The  aim  of  this  work  is  to  present  the  facts 
of  human  anatomy  in  a  plain,  practical  way, 
which  will  be  alike  suitable  for  student,  phy- 
sician or  surgeon.  It  will  be  divided  into  six 
sections,  each  of  which  will  be  enclosed  in  an 
individual  pore-folio.     Price,  per  section,  $3.50. 

The  first  treats  of  histology,  and  is  rather 
brief  for  a  work  of  such  pretensions,  but  the 
style  is  clear,  and  the  printing,  paper,  and  plates 
are  excellent.  It  is  from  the  well-known  and 
able  pen  of  Dr.  E.  O.  Shakespeare,  of  Phila- 
delphia. 

Section  two  deals  with  the  bones  and  joints, 
and  is  contributed  by  the  auihor ;  the  drawings 
being  made  by  Hermann  Faber  from  the  author's 
dissections.  The  plates  are  almost  without  ex- 
ception very  good,  and  the  names  of  parts  are 
clearly  drawn  upon  the  figures  after  the  manner 
of  Holden  and  Gray.  On  the  advantage  of 
this,  there  may,  of  course,  be  fairly  two  opinions. 
The  letter-press  is  very  clear,  concise,  and  com- 
prehensive, being  at  once  lucidly  descriptive, 
and  at  the  same  time  throwing  a  flood  of  light 
on  the  applicability  of  anatomical  facts  to  the 


OF  MEDICAL  SCIENCE. 


411 


daily  uses  of  clinical  suigery  and  medicine. 
The  work  will  certainly  assume  an  unoccupied 
place  in  American  Medical  Literature,  and  re- 
dound alike  to  the  author's  credit,  and  the 
benefit  of  those  who  may  become  its  possessors. 

Diseases  of  the  Rectum  and  Ames.     By  Charles 
B.  Kelsey,  M.D.,  Surgeon  to  St.  Paul's  In- 
firmary for  Diseases  of  the  Rectum.     New 
York :  Wm.  Wood  &  Co.     Toronto  :    Will- 
ing &  Williamson,  1882. 
The  August  No.  of  Wood's  Library  consti- 
tutes one  of  the  best  books  of  the  series,  and 
it  bears  the  above  title.     Within  its  limits  Dr. 
Kelsey  has  endeavoured,  and  successfully  so,  to 
compress  the  greater  part  of  all  contributions 
to  our  knowledge  of  the  subjects  which  are  of 
positive  value  from  all  sources,  the  labours  of 
his  fellow-townsman,  Yan  Buren,  probably  re- 
ceiving less  acknowledgment  than  they  deserve. 
The  work  opens  with  some  practical  points  in 
anatomy   and  physiology  which  are  of  much 
value;  followed  by    an  excellent   chapter   on 
congenital   malformations   of  the  rectum  and 
anus.       General  rules  regarding  examination, 
diagnosis,  and  operation  are  then  given.     The 
author  is  a  strong  advocate  of  forcible  dilata- 
tion of  the   anus,    both  for  examination   and 
operation,  and  his   method  of  its  accomplish- 
ment is  somewhat  different  from  most.    Inflam- 
mation, abscess  and  fistula,  and  haemorrhoids 
are  then  considered  in  different  chapters,  and 
in  the  last  named  we  regret  to  notice  omission 
of  any   mention  of  Pollock's  crushing  method, 
or   Benham's,    or    AUingham's    modifications. 
Like  most  of  the  authorities  Kelsey  prefers  the 
ligature  to  all  other  methods.     In  the  chapter 
on  prolapse  the  author  extends  the  use  of  inter- 
stitial injections  of  carbolic  acid,  found  so  useful 
in   piles,  to  the  relief  of  this  condition  also. 
Non-malignant  growths,  non-malignant  ulcera- 
tion, and  non-malignant  stricture  are  ably  dis- 
cussed in  the  next  three  chapters.     In  the  last 
named  affection  the  author  is  an  able  and  con- 
sistent advocate   with  the   French  authorities 
of  linear  proctotomy  instead  of  colotomy  as  an 
ultimate  resort.     The  chapter  on  cancer  is  a 
very  good  one,  and  the  subject  is  discussed  in 
all  its  bearings.     Impacted  faeces,  and  foreign 
bodies,  pruritus  ani,  and  spasm  of  the  sphincter, 
neuralgia,  wounds,  and  rectal  alimentation  in 


three  shorter  chapters  complete  the  volume. 
The  addition  of  another  good  work  on  the  rec- 
tum to  those  we  already  possess  constitutes  a 
veritable  embarras  de  richesses. 


Slight  Ailments — Tlieir  Nature  and  Treatment. 
By  Lionel  S.  Beale,  M.B.,  F.R.S.  Second 
edition,  enlarged  and  illustrated.  Philadel- 
phia :  P.  Blakiston,  Son  &  Co,  Toronto  : 
N.  Ure  &  Co. 

Though  we  cannot  say  of  this  little  book  that 
it  supplies  that  oft-mentioned  desideratum,  "  a 
want  long    felt,"  we  can  say   of  it  that  it  is 
useful  in  its  place,  and  one  that  may  be  profit- 
ably read  by  students,  young  practitioners,  and 
even   old   practitioners,  both  licensed  and  un- 
licensed.    It  deals  chiefly  with  those  so-called 
functional     derangements,     which    are    often 
brought  before  the   notice  of  the  doctor,  and 
often,  unfortunately   for    both   physician   and 
patient,  regarded  lightly,  and  even  contemptu- 
ously by  the  former,  and  dosed  and  redosed  rep  at- 
edly  and  ineffectually  with  patent  medicines  by 
the  latter.    Dr.  Beale  rightly  urges  that, the  phy- 
sician should,  in  dealing  with  what  he  may  in  the 
omnipotence  of  his   scientific,  anatomical,  and 
pathological  mind,  regard  as  slight  ailments  un- 
worthy of  his  notice,  put  himself  in  his  patient's 
place,  and  condescend  to  descend  to  their  level  of 
knowledge  and  thought.     By  doing  so,  he  will 
save  his  patients  much  useless  expense,  find  that 
he  can  relieve   much  real   suffering,   and    de- 
prive the  patentees,  and  vendors  of  quack  rem- 
edies of  much  ill-gotten  gain  and  repute.     The 
book  takes  notice  of   many  points,  trifling  in 
themselves,  that  conduce  to  a  physician's  success 
or  failure,  and  his  patient's  comfort  or  dissatis- 
faction.    There  are  some  remarks  on  quackery 
and  medical  humbug,  apropos  to  all  times  and 
countries  that  will  strike   every  well-balanced 
mind  as  only  too  true.    The  following  quotation 
is  a  fair  sample  of  this  : — **  Men  high  among  the 
most  intelligent  and  most  learned,    nay,  men 
who  have  been  looked  up  to   as    men    of  the 
world,  have  often  been  humbugged  in  matters 
medical,  and  even  profound  lawyers  have  failed 
to  distinguish   medical  nonsense  from  medical 
sense,  and  mere  sham  science  from  real  scientific 
knowledge.     Those    who   are   always   guaging 
the  value  of  evidence  and  devoting  themselves 
to  the  extraction  of  truth,  seem  to  be  specially 


412 


CANADIAN  JOURNAL 


susceptible  to  medical  and  scientific  imposition." 
We  have  not  space  to  more  than  name  the 
headings  under  which  Dr.  Beale  deals  with  his 
subject.  After  the  introduction,  to  which  we 
have  briefly  referred,  come  chapters  on  (a) 
Tongue  in  Health  and  Slight  Ailments.  (6) 
Appetite,  Nausea,  Thirat,  Hunger,  (c)  Indi- 
gestion, (d)  Constipation,  (e)  Diarrhcea.  (/") 
Worms,  (g)  Vertigo.  (/<)  Biliousness,  Sick 
Headache,  (j)  Neuralgia,  Rheumatism,  (k) 
Fever  and  Inflammation. — All  written  in  such 
simple  language,  that,  "  he  who  runs  may 
read,"  mark,  learn,  and  profitably  digest. 

TORONTO  MEDICAL  SOCIETY. 

REGULAR  MEETING,  AUGUST  31,  1882. 

In  the  absence  of  the  President  and  Vice- 
Presidents,  Dr.   Macdonald  occupied  the  chair. 

Dr.  Machell  showed  an  anencephalic  monster 
with  two  rows  of  tubercles  extending  as  low  as 
the  lower  dorsal  vertebrae,  due  either  to  spina 
bifida,  or  a  double  row  of  spinous  processes. 

Dr.  McPhedran  stated  that  microscopical  ex- 
amination of  the  ruptured  uterus  presented  at 
the  last  meeting  of  the  Society  showed  marked 
granular  degeneration  at  seat  of  rupture. 

Dr.  Workman  read  a  paper  on  Myxoedema, 
or  Pachydermic  Cachexia,  embracing  a  full  re- 
sum6  of  the  well-known  views  of  Gull,  Ord, 
Mahomed,  Goodhart,  Charcot,  and  Hadden. 
The  paper  was  a  translation  from  the  Rivista 
Sperimentale. 


REGULAR  MEETING,  SEPTEMBER  21,    1882. 

The  President,  Dr.  George  Wright,  in  the 
chair. 

Dr.  McPhedran  showed  a  boy,  aged  6,  with 
well  marked  summer  prurigo.  The  eruption 
first  showed  itself  early  in  the  summer  of  last 
year,  continuing  till  the  cold  weather  came 
when  it  wholly  disappeared  and  returned  again 
with  the  warm  weather  this  summer.  It  is 
much  worse  this  year  than  last.  The  family 
history  contains  nothing  of  importance.  The 
child  is  vigorous  and  healthy.  The  eruption 
consists  of  pinkish  papules  varying  in  size  from 
a  pin's  head  to  three  or  four  times  that  size ; 


the  apex  capped  with  a  thin  whitish  scale ;  in 
many  of  the  papules  the  scale  is  replaced  by  a 
scab.  The  papules  appear  on  all  i)arts  except 
the  scalp,  upper  part  of  face,  axillae,  anal  fissure, 
scrotum,  and  palms  and  soles.  It  is  most 
abundant  on  the  outer  aspects  of  legs  and  arms 
where  the  skin  is  thickened,  harsh,  and  dry, 
and  scratch-marks  and  scabs  very  numerous. 
At  night  the  itching  is  intense,  but  only  slight 
during  the  day.  Treatment  has  resulted  in  no 
benefit  thus  far.  Sulphur  and  tar  baths  had 
been  tried  but  the  facilities  for  prolonged  bath- 
ing were  wanting.  Arsenic,  iron,  and  cod  liver 
oil  had  been  given  internally. 

Dr.  Graham  said  the  case  was  a  most  typical 
one  of  summer  prurigo  as  described  by  Hutch- 
inson. He  had  had  two  cases  in  his  practice, 
but  they  were  complicated  by  wheals  and 
might  be  looked  upon  as  lichen  urticatus.  He 
had  recently  seen  a  case  of  the  inveterate 
prurigo  of  Hebra  much  benefitted  by  naphthone 
ointment. 

Dr.  Cameron  said  he  had  a  similar  case  to 
the  one  exhibited,  of  three  years  standing  in 
an  adult,  under  his  care.  He  was  inclined  to 
think  that  true  prurigo  was  of  more  frequent 
occurrence  than  stated  by  the  authorities.  He 
saw  a  case  some  years  ago. 

Dr.  Oldright  showed  a  case  of  leucoderma 
in  a  man  aged  28.  Began  two  years  ago,  and 
occurred  in  small  spots  chiefly  on  right  side  of 
chin  and  neck. 

Dr.  Cameron  said  he  had  a  similar  but  more 
marked  case  under  his  care  at  the  General 
Hospital  at  present ;  the  hyperpigmentation 
around  the  leucoderraic  spots  being  very  dis- 
tinct. He  advised  liquor  epispasticus  locally 
and  cod  liver  oil,  phosphorus,  phosphides,  espe- 
cially phosphide  of  silver,  etc.,  internally. 

Dr.  Graham  saw  a  case  treated  successfully 
temporarily  at  last  by  mustard  plasters. 

Dr.  McPhedran  next  showed  a  case  of  tuber- 
cular and  bullous  eruption  in  a  young  woman, 
possibly  due  to  the  bites  of  the  cimex  lectu- 
larius. 

Dr.  Geo.  Wright  read  a  paper  on  Rbtheln. 
He  gave  a  full  description  of  the  disease  and 
its  treatment,  and  traced  its  history  from  the 
time  the  first  descriptions  were  given  of  it  as  a 
form   of  measles  or  scarlatina,  or  a  hybrid  of 


OF  MEDICAL  SCIENCE. 


413 


both,  one  hundred  or  more  years  ago,  to  the 
pi'esent,  when  it  is  acknowledged  an  essential 
fever. 

Dr.  Cameron  preferred  the  name  Rubella,  as 
suggested  by  the  American  Dermatotogical 
Association.  He  said  there  had  been  an  out- 
break of  rubella  at  the  House  of  Providence 
during  the  past  summer,  and  continuous  with 
it  another  of  measles.  There  were  no  deaths 
in  the  former  but  a  large  number  of  cases  had 
terminated  fatally  in  the  latter. 

Dr.  Graham  said  an  outbreak  of  rubella  oc- 
curred in  Brampton  in  1872,  and  was  described 
in  an  article  in  the  Canada  Lancet  by  Dr. 
Heggie.  This  was  a  year  before  the  first  out- 
break in  New  York,  which  Dr.  J.  Lewis  Smith 
stated  occurred  in  1873,  as  given  in  the  paper 
just  read. 

Dr.  A.  H.  Wright  said  a  wide-spread  epi- 
demic occurred  in  Colborno,  Ont.,  during  the 
second  year  he  was  in  practice,  and  had  given 
much  concern  to  the  practitioners  in  that  district. 
He  thought  there  was  great  difficulty  in  diag- 
nosis owing  to  the  varying  character  of  the 
symptoms. 

Dr.  Oldright  said  outbreaks  of  what  was 
called  "  hybrid  "  measles  and  scarlet  fever  by 
the  leading  physicians,  occurred  in  Toronto 
during  1863-65. 

Dr.  Temple  said  an  outbreak  had  occurred 
in  one  of  the  ladies'  schools  during  the  recent 
epidemic,  and  asked  the  opinion  of  the  Society 
on  the  advisability  of  closing  the  school. 

In  reply,  Dr.  Cameron  said  he  thought  the 
school  should  not  be  closed  but  quarantined,  as 
the  poison  being  disseminated  in  the  early 
stages  of  the  fever  would  be  carried  home  by 
the  ladies  if  the  school  was  closed. 

Dr.  McFarlane  said  he  had  some^very  severe 
cases  during  the  recent  epidemic,  one  child  hav- 
ing died.  In  this  case  the  rash  came  out 
quickly  all  over  the  body ;  was  abundant, 
bright  colored  at  first,  but  became  dai-ker  in  a 
few  hours.  The  child  died  exhausted.  He 
believed  the  disease  was  most  likely  confounded 
with  scarlet  fever. 

Dr.  Nevitt  agreed  with  Dr.  A.  H.  Wright 
as  to  the  great  difficulty  in  making  the  diagnosis 
in  many  cases. 

The  Society  then  adjourned. 


(Regular  Meeting,  October  5th,  1882.) 

The  President,  Dr.  George  Wright,  in  the 
chair.  Dr.  Spencer  showed  a  woman  with  an 
eruption,  probably  syphilitic,  chiefly  on  the  face, 
neck,  and  forearms.  Treatment  had  not  been  fol- 
lowed by  much  benefit.  Dr.  Cameron  advised 
giving  iodide  of  potassium  in  much  larger 
doses  than  hnd  been  given. 

Dr.  A.  H,  Wright  showed  fractured  os 
innominatum  and  spine.  (See  report  in  this 
issue.) 

Dr.  Nevitt  showed  an  exostosis  removed 
from  the  ungual  phalanx  of  the  great  toe  of  a 
young  girl. 

Dr.  Macdonald  reported  a  case  of  epithe- 
lioma of  the  uterus  and  vagina  in  a  woman,  a 
farmer's  wife,  aged  60.  Symptoms  first  showed 
themselves  last  April  in  a  bloody  vaginal  dis- 
charge, lasting  for  a  day  or  two,  and  recurring 
from  time  to  time.  No  pain  or  hydrorrhoea. 
He  removed  as  much  as  possible  of  the  growths, 
to  mitigate  symptoms  and  prolong  life. 

Dr.  Nevitt  said  he  had  a-  similar  case  at 
present  under  his  care.  He  was  applying  the 
fuming  nitrac  acid,  much  to  the  relief  of  the 
patient.  Both  pain  and  hydrorrhoea  were 
marked. 


(Regular  Meeting,  October  9th,  1882.) 
The  President,  Dr.    George  Wright,  in  the 
chair.     Dr.  Holmes  was  elected  &  member  of 
the  Society. 

Dr.  Reeve  exhibited  a  patient  illustrating 
the  treatment  of  Ectropion  by  transplantation 
of  flap  without  pedicle,  and  gave  an  elaborate 
description  of  the  various  steps  of  the  opera- 
tion. The  case  was  a  marked  example  of  cica- 
tricial keloid  resulting  from  a  burn.  The 
upper  lid  had  been  treated  by  transplantation 
two  years  ago  with  the  most  satisfactory  result. 
The  operation  on  the  present  occasion  was  for 
the  restoration  of  the  lower  lid.  The  extent 
of  raw  surface  made  was  25  x  15  mm.,  and  a 
flap  65  X  40  mm.  was  transplanted  from  the 
inner  side  of  the  arm.  The  operation  was 
performed  three  weeks  ago,  and  the  flap  had 
united  perfectly.  This  was  the  fifth  case  oper- 
ated on  by  Dr.  Reeve,  of  which  four  were 
completely  successful.  In  answer  to  Dr.  Cam- 
eron, Dr.  Reeve  said  he  had  not  tried  treatment 


i\4 


OANADIAN  JOURNAL  OF  MP^DICAL  SCIENCK. 


of  keloid  bv  friction  with  nand  ;  that  the  mode 
of  oi>erating  by  transplantation  without  pedicle 
was  that  developed  by  Wolfe,  of  Glasgow  ; 
and  that  no  keloid  had  formed  on  the  arm  as  a 
result  of  the  removal  of  the  flap. 

Dr.  Zimmerman  reported  a  case  of  malignant 
disease  in  a  compositor.  (Appears  in  this 
issue.)  Dr.  Zimmerman  said  the  disease  was 
rare  in  the  supra-renal  capsules,  esj)eciiilly  in 
one  alone,  and  it  would  be  interesting  to  know 
if  the  capsule  had  been  primarily  diseased  in 
this  case.  In  reply  to  Dr.  Cameron,  he  said 
the  frequency  of  malignant  disease  of  the 
pelvic  tissues  in  young  people  might  be  due  to 
great  activity  of  the  sympathetic. 

Dr.  Graham  reported  a  case  of  abscess  of  the 
tongue.  It  was  the  first  case  he  had  seen. 
Drs  Workman  and  Machell  had  seen  cases. 

Dr.  Graham  reported  a  case  of  a  child,  aged 
three  years,  with  symptoms  resembling  those 
of  leucocythemia.  Splenic  dullness  was  in- 
creased ;  the  red  corpuscles  about  f  normal 
number ;  and  white  corpuscles  in  proportion  of 
1  to  20  red  ones.  No  history  of  ague.  The 
case  might  be  anaemia,  with  splenic  and  glan- 
dular enlargements. 

Dr.  Cameron  said  he  saw  one  exactly  similar 
two  months  ago. 

Dr.  Graham  reported  a  case  exhibiting  symp- 
toms of  bulbar  anaemia  in  a  man  aged  48. 
The  man  had  for  years  devoted  himself  closely 
to  business,  and  suffered  from  debility  in  conse- 
quence. He  went  to  Europe  last  spring,  and 
on  the  voyage  was  seized  with  an  attack  of 
dyspnoei;  another  in  London.  On  Oct.  5  Dr. 
Graham  was  called  hurriedly  at  night  to  see 
him.  He  had  awakened  with  another  attack. 
In  this  there  were  a  number  of  superficial  res- 
pirations, followed  by  a  deep  one.  No  chest 
symptoms.  Next  day,  while  receiving  an  ap- 
plication to  the  throat,  was  again  seized.  No 
Hpasm  of  vocal  curds  during  this  seizure. 
Memory  is  failing  ;  he  has  become  very  emo- 
tional ;  is  very  temperate  ;  no  venereal  history ; 
urine  normal ;  no  optic  neuritis. 

Dr.  Cameron  inclined  to  the  view  that  tu- 
mour of  the  brain  was  the  cause.  Such  symp- 
toms might  arise  from  a  form  of  epilepsy. 

Dr.  Reeve  said  the  absence  of  optic  neuritis 
did  not  exclude  tumour  of  the  brain,  as  tumour 
may  exist  for  years  and  neuritis  only  develop  a 
short  time  before  death. 


Dr.  Graham  exhibited  pulse  tracings  from  a 
case  of  aortic  regurgitant  disease  in  a  fish  ped- 
lar. No  symptoms  till  two  weeks  ago.  He 
was  passed  a  short  time  ago  for  life  assurance. 
He  believed  the  case  one  of  idiopathic  endocar- 
ditis.    (See  clinic  in  this  issue.) 

Dr.  McPhedran  reported  a  case  of  hemi- 
plegia in  a  man  aged  28,  due  apparently  to 
embolism.  The  heart  in  normal  ;  no  history  of 
inflammatory  rheumatism  or  syphilis. 

Dr.  Graham  then  read  a  paper  on  Lupus, 
giving  the  history  of  six  cases,  illustrating  the 
different  varieties.  He  believed  L.  Erythema- 
tosus and  li.  Vulgaris  to  be  similar  in  patholo- 
gical character,  the  difference  being  due  to  the 
seat  of  the  deposit.     Prognosis  always  bad. 

Dr.  Cameron  adopted  the  view  of  Fried- 
lander  that  the  two  forms  of  Lupus  are  distinct 
pathologically.  He  advised  treatment  by 
oblique  linear  scarification  or  erasion,  to  cut  off 
the  blood  supply,  followed  by  application  of 
iodoform  and  pressure. 

Dr.  Workman  brought  to  the  notice  of  the 
Society  the  desirability  of  establishing  a  regis- 
try of  nurses  for  Toronto.  Owing  to  the 
lateness  of  the  hour  the  subject  was  deferred 
till  next  meeting.     (See  Editorial.) 


^iml\mtm$. 


CLOSURE  OF  SCHOOLS  OWING  TO' 
PREVALENCE  OF  ZYMOTIC  DIS- 
EASES. 

The  conclusions  of  a  paper  on  this  impor- 
tant subject,  read  at  the  last  meeting  of  the 
British  Medical  Association,  by  Mr.  11.  Page, 
M.R.C.S.,  S.So.C.  Camb.,  Ex-Med.  Officer  of 
Health,  Redditch  Urban  Sanitary  District,  are 
as  follows : — 

1.  Where  there  is  no  compulsory  notifica- 
tion of  infectious  diseases,  it  is  necessary  to 
close  schools,  as  soon  as  it  is  evident  that  they 
are  acting  as  centres  of  infection  ;  but  that 

2.  Where  there  is  compulsory  notification, 
and  the  knowledge  so  acquired  is  efficiently 
utilized,  and  its  necessary  adjunct — -proper 
means  for  isolation  of  cases,  that  is,  hospital 
accommodation — exists,  the  control  of  zymotic 
diseases  is  so  complete,  and  the  consequent 
protection  of  schools  from  the  introduction  of 
contagion  so  efficient,  it  is  extremely  seldom 
that  it  is  necessary  to  require  their  closure. 


IINDING  LIST    SEP  1     1936 


The  Canadian  practitioner 


R 
11 
C^5 
v,7 

Biolo^icai 
&  Medical 
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